Provider Demographics
NPI:1205116613
Name:MASKELL, CATHERINE SANDERS (ARNP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:SANDERS
Last Name:MASKELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 S I ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5016
Mailing Address - Country:US
Mailing Address - Phone:253-428-8700
Mailing Address - Fax:253-292-4159
Practice Address - Street 1:1624 S I ST
Practice Address - Street 2:SUITE 102
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5016
Practice Address - Country:US
Practice Address - Phone:253-428-8700
Practice Address - Fax:253-292-4159
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60221984363LA2100X
VA0024171697363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09633OtherGROUP PTAN