Provider Demographics
NPI:1992704001
Name:BUSHFIELD, KATHRYN G (RN, ARNP, CRNA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:G
Last Name:BUSHFIELD
Suffix:
Gender:F
Credentials:RN, ARNP, CRNA
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 6989
Mailing Address - Street 2:MAIL STOP 18913
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-6989
Mailing Address - Country:US
Mailing Address - Phone:360-658-2700
Mailing Address - Fax:360-658-5091
Practice Address - Street 1:10330 MERIDIAN AVE N
Practice Address - Street 2:#370
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9451
Practice Address - Country:US
Practice Address - Phone:206-528-6000
Practice Address - Fax:206-528-0014
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00099117163W00000X
WAAP30004033367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9618372Medicaid
WA8800899Medicare ID - Type UnspecifiedSMOKEY POINT CLINIC
WA9618372Medicaid
WA8800903Medicare ID - Type UnspecifiedSEATTLE CLINIC