Provider Demographics
NPI:1053412205
Name:ROFF-CRANE, DAWNA RUTH (ARNP)
Entity type:Individual
Prefix:
First Name:DAWNA
Middle Name:RUTH
Last Name:ROFF-CRANE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:425-317-0279
Mailing Address - Fax:425-317-0291
Practice Address - Street 1:1330 ROCKEFELLER AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1684
Practice Address - Country:US
Practice Address - Phone:425-261-4925
Practice Address - Fax:425-261-4932
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000906363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9629791Medicaid
WAG8878368Medicare PIN
WAS67900Medicare UPIN
WA9629791Medicaid