Provider Demographics
NPI:1386620896
Name:STURSOVA-WOLFF, KATERINA (MD)
Entity type:Individual
Prefix:MRS
First Name:KATERINA
Middle Name:
Last Name:STURSOVA-WOLFF
Suffix:
Gender:F
Credentials:MD
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 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-397-1702
Mailing Address - Fax:425-335-5145
Practice Address - Street 1:8910 VERNON RD
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-2400
Practice Address - Country:US
Practice Address - Phone:425-397-1702
Practice Address - Fax:425-335-5145
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60451748208000000X
MA216086208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH70062Medicare UPIN
MAA24639Medicare ID - Type Unspecified