Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP30000906 | WA |
NPI | 1053412205 |
---|---|
Provider Name | Dawna Ruth Roff-Crane |
First Address | Portland, OR 97208-3360 |
Second Address | Everett, WA 98201-1684 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9629791 | (05) | WA |
S67900 | (02) | WA |