Provider Demographics
NPI:1396131975
Name:HARSTROEM, CAROLINE ALEXANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:ALEXANDRA
Last Name:HARSTROEM
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 1:801 SW 16TH ST STE 121
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2628
Mailing Address - Country:US
Mailing Address - Phone:206-538-6300
Mailing Address - Fax:206-538-6301
Practice Address - Street 1:3305 NASSAU ST STE A
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4140
Practice Address - Country:US
Practice Address - Phone:206-538-6300
Practice Address - Fax:206-538-6301
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFE.60964666207LP2900X
WAMD61097991208VP0000X, 208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2136213Medicaid