Healthcare Provider Details

I. General information

NPI: 1053412205
Provider Name (Legal Business Name): DAWNA RUTH ROFF-CRANE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 ROCKEFELLER AVE SUITE 230
EVERETT WA
98201-1684
US

IV. Provider business mailing address

PO BOX 3360
PORTLAND OR
97208-3360
US

V. Phone/Fax

Practice location:
  • Phone: 425-261-4925
  • Fax: 425-261-4932
Mailing address:
  • Phone: 425-317-0279
  • Fax: 425-317-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP30000906
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: