Healthcare Provider Details

I. General information

NPI: 1295099380
Provider Name (Legal Business Name): DONNA LEANNE EWANOWICH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 9TH AVE MS:M4-PFS
SEATTLE WA
98101-2756
US

IV. Provider business mailing address

1100 9TH AVE MS:M4-PFS
SEATTLE WA
98101-2756
US

V. Phone/Fax

Practice location:
  • Phone: 206-515-5811
  • Fax:
Mailing address:
  • Phone: 206-515-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP60302473
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00120850
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN076386
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN091720
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN209836
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number187422-2
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number037923-21
License Number StateNH
# 8
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number55791
License Number StateSC
# 9
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number567161
License Number StateTX
# 10
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number132181
License Number StateWI
# 11
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number544776
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: