Provider Demographics
NPI:1194498345
Name:WODAEGE, KATIE ELIZABETH (CNM, ARNP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ELIZABETH
Last Name:WODAEGE
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-1008
Mailing Address - Country:US
Mailing Address - Phone:360-413-8413
Mailing Address - Fax:360-413-7143
Practice Address - Street 1:615 LILLY RD NE STE 200
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5137
Practice Address - Country:US
Practice Address - Phone:360-413-8413
Practice Address - Fax:360-413-7143
Is Sole Proprietor?:No
Enumeration Date:2021-07-25
Last Update Date:2022-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61230409367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife