Basic Information
| Provider Information | |||||||||
| NPI: | 1891723722 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BONN | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | ARNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BONN | ||||||||
| OtherFirstName: | KATIE | ||||||||
| OtherMiddleName: | J. | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 325 9TH AVE | ||||||||
| Address2: | BOX 359797 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067449600 | ||||||||
| FaxNumber: | 2067449920 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 9TH AVE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067443000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 06/24/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP30006583 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0808X | AP30006583 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 9640350 | 05 | WA | MEDICAID | 0181290 | 01 | WA | L&I PIN | OTHER | 21986U | 01 | WA | REGENCE BLUE SHIELD PIN | OTHER |