Provider Demographics
NPI:1134517832
Name:CROUSE, SALLY ANNE
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANNE
Last Name:CROUSE
Suffix:
Gender:F
Credentials:
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 1289
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-4289
Mailing Address - Country:US
Mailing Address - Phone:360-794-7699
Mailing Address - Fax:
Practice Address - Street 1:20721 95TH ST SE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-7255
Practice Address - Country:US
Practice Address - Phone:360-794-7699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-03
Last Update Date:2015-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00004815OtherDOH
WA917711OtherDSHS