Individual
KATHERINE R TUTTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
105 W 8TH AVE, STE 7060, SPOKANE, WA 99204-2302
(509) 340-0930
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD00028218
WA
207RN0300X
Nephrology Physician
Primary
MD00028218
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010156204
REGENCE BLUE SHIELD OF ID
ID
05
—
003311300
—
ID
05
—
0154241
—
MT
01
—
0209480
L&I
WA
01
—
4138520
AETNA PROVIDER #
WA
01
—
6363TU
ASURIS RIDER #
WA
01
—
AB32999
MEDICARE GROUP
WA
Enumeration date
08/29/2006
Last updated
04/23/2021
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