Healthcare Provider Details

I. General information

NPI: 1679254106
Provider Name (Legal Business Name): ANA MARIA MORALES CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 03/12/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 GEORGE WASHINGTON WAY
RICHLAND WA
99354-2626
US

IV. Provider business mailing address

PO BOX 2928
PORTLAND OR
97208-2928
US

V. Phone/Fax

Practice location:
  • Phone: 888-227-3312
  • Fax: 509-942-3050
Mailing address:
  • Phone: 425-209-5155
  • Fax: 509-942-3050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61469265
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP61469265
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61469265
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: