Provider Demographics
NPI:1992942627
Name:KATHERINE J. MIKITA
Entity type:Organization
Organization Name:KATHERINE J. MIKITA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIKITA
Authorized Official - Suffix:
Authorized Official - Credentials:GNP/ARNP
Authorized Official - Phone:253-752-6621
Mailing Address - Street 1:5340 N BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-2204
Mailing Address - Country:US
Mailing Address - Phone:253-752-6621
Mailing Address - Fax:253-756-7179
Practice Address - Street 1:5340 N BRISTOL ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-2204
Practice Address - Country:US
Practice Address - Phone:253-752-6621
Practice Address - Fax:253-756-7179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA452314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility