1457892291 NPI number — PROFESSIONAL REGISTRY OF NURSING, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457892291 NPI number — PROFESSIONAL REGISTRY OF NURSING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL REGISTRY OF NURSING, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457892291
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10828 GRAVELLY LAKE DR SW
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98499-1334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-617-7715
Provider Business Mailing Address Fax Number:
253-589-1514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10828 GRAVELLY LAKE DR SW
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-1334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-617-7715
Provider Business Practice Location Address Fax Number:
253-589-1514
Provider Enumeration Date:
03/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
CROSBY
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
253-617-7715

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  NPOL.NR.00000237 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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