Healthcare Provider Details

I. General information

NPI: 1710508247
Provider Name (Legal Business Name): GINA MARIE CROPPI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 FAWCETT AVE STE 101
TACOMA WA
98402-5502
US

IV. Provider business mailing address

909 N I ST UNIT 302
TACOMA WA
98403-2135
US

V. Phone/Fax

Practice location:
  • Phone: 253-207-4318
  • Fax:
Mailing address:
  • Phone: 253-973-8780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN00116342
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: