Healthcare Provider Details

I. General information

NPI: 1245312552
Provider Name (Legal Business Name): RYAN W MCDONALD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 S 23RD ST SUITE 340
TACOMA WA
98405-1602
US

IV. Provider business mailing address

2420 S UNION AVE STE 200
TACOMA WA
98405-1323
US

V. Phone/Fax

Practice location:
  • Phone: 253-272-5127
  • Fax:
Mailing address:
  • Phone: 253-503-2598
  • Fax: 253-404-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30007531
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: