Provider Demographics
NPI:1154734549
Name:STANTON, KATRINA MARIE
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARIE
Last Name:STANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 NW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-5609
Mailing Address - Country:US
Mailing Address - Phone:360-672-0583
Mailing Address - Fax:
Practice Address - Street 1:107 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3541
Practice Address - Country:US
Practice Address - Phone:360-682-6154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator