Provider Demographics
NPI:1316454234
Name:MOONAN, CATHERINE ANN (FNP-C)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:MOONAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 8TH AVE S STE 2
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3032
Mailing Address - Country:US
Mailing Address - Phone:206-788-3700
Mailing Address - Fax:
Practice Address - Street 1:3815 S OTHELLO ST STE 2
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3510
Practice Address - Country:US
Practice Address - Phone:206-788-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-30
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01740363LF0000X
CT147769363LF0000X
WAAP60972605363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP60972605OtherWASHINGTON STATE ARNP LICENSE