MEDICARE: MS. KATSUKO TANAKA ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	RN00086690	WA
2	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	AP30002001	WA

General Provider Information

NPI Number	:	1083717904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATSUKO TANAKA ARNP

Provider Business Mailing Address
First Line	:	4700 42ND AVE SW
Second Line	:	SUITE 430
City	:	SEATTLE
State	:	WA
Zip	:	98116-4591
Country	:	US
Telephone Number	:	206-933-0699
Fax Number	:	206-932-6045

Provider Business Practice Location Address
First Line	:	4700 42ND AVE SW
Second Line	:	SUITE 430
City	:	SEATTLE
State	:	WA
Zip	:	98116-4591
Country	:	US
Telephone Number	:	206-933-0699
Fax Number	:	206-932-6045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	09/30/2011

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