Provider Demographics
NPI:1992508014
Name:BLOMGREN, KATHERINE BRIANNE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BRIANNE
Last Name:BLOMGREN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 SE SHOEMAKER PL
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5528
Mailing Address - Country:US
Mailing Address - Phone:208-651-3334
Mailing Address - Fax:
Practice Address - Street 1:920 6TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2079
Practice Address - Country:US
Practice Address - Phone:509-254-5053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program