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General NPI Number Information
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NPI Number | 1457892291
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL REGISTRY OF NURSING, INC.
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 10828 GRAVELLY LAKE DR SW SUITE 201
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City | LAKEWOOD
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State | WA
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Zip | 98499-1334
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Country | US
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Telephone | 253-617-7715
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Fax | 253-589-1514
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Provider Business Mailing Address
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Address Line | 10828 GRAVELLY LAKE DR SW SUITE 201
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City | LAKEWOOD
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State | WA
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Zip | 98499-1334
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Country | US
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Telephone | 253-617-7715
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Fax | 253-589-1514
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JERRY L CROSBY
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Credential |
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Telephone | 253-617-7715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | NPOL.NR.00000237
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License Number State | WA
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