Provider Demographics
NPI:1386918126
Name:SANDERSON, KATHERINE BERNICE (LM)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:BERNICE
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 PACIFIC AVE - SE (AROUND THE CIRCLE MIDWIFERY)
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4753
Mailing Address - Country:US
Mailing Address - Phone:360-459-7222
Mailing Address - Fax:360-459-7223
Practice Address - Street 1:2120 PACIFIC AVE - SE (AROUND THE CIRCLE MIDWIFERY)
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4753
Practice Address - Country:US
Practice Address - Phone:360-459-7222
Practice Address - Fax:360-459-7223
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60683812176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2072452Medicaid