Provider Demographics
NPI:1992280796
Name:KATIYO, WINNET (ARNP)
Entity type:Individual
Prefix:
First Name:WINNET
Middle Name:
Last Name:KATIYO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:WINNET
Other - Middle Name:K
Other - Last Name:TANNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1207 W 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:LA CENTER
Mailing Address - State:WA
Mailing Address - Zip Code:98629-3166
Mailing Address - Country:US
Mailing Address - Phone:919-559-1002
Mailing Address - Fax:
Practice Address - Street 1:1251 LEWIS RIVER RD STE D
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674-9203
Practice Address - Country:US
Practice Address - Phone:360-225-4310
Practice Address - Fax:360-225-4339
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60909332363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2120996Medicaid