Healthcare Provider Details

I. General information

NPI: 1104868751
Provider Name (Legal Business Name): EIRENE SARAH KRANICK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EIRENE BEACH RN

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 03/07/2023
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4462 BOB SCHULTZ RD
COLFAX WA
99111-8683
US

IV. Provider business mailing address

6332 MT BAKER HWY
DEMING WA
98244-9547
US

V. Phone/Fax

Practice location:
  • Phone: 425-344-8123
  • Fax:
Mailing address:
  • Phone: 425-344-8123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30007312
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: