Provider Demographics
NPI:1194087866
Name:MCGIFFIN, KATRINA MARIE (MS, CN)
Entity type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:MARIE
Last Name:MCGIFFIN
Suffix:
Gender:F
Credentials:MS, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 N LUCAS PL
Mailing Address - Street 2:UNIT 201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8159
Mailing Address - Country:US
Mailing Address - Phone:310-625-6628
Mailing Address - Fax:
Practice Address - Street 1:5340 BALLARD AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4060
Practice Address - Country:US
Practice Address - Phone:310-625-6628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU 60242396133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist