Healthcare Provider Details

I. General information

NPI: 1750729356
Provider Name (Legal Business Name): NICOLE MARGARET CRUVER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE MARGARET CRUVER WENK ARNP

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E MAIN ST STE 100
AUBURN WA
98002-4905
US

IV. Provider business mailing address

3600 LIND AVE SW SUITE 100 ATTN CREDENTIALING
RENTON WA
98057-4970
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3480
  • Fax: 425-690-9480
Mailing address:
  • Phone: 425-690-2715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60468077
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP60468077
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: