Provider Demographics
NPI:1336285410
Name:CROWDER, CAROLE A (ARNP)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:A
Last Name:CROWDER
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 34584
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1584
Mailing Address - Country:US
Mailing Address - Phone:509-241-7349
Mailing Address - Fax:509-241-7628
Practice Address - Street 1:209 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4265
Practice Address - Country:US
Practice Address - Phone:253-596-3540
Practice Address - Fax:253-596-3556
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00054568363L00000X
WAAP30005542363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9631649Medicaid
WAGAB25046Medicare PIN
WAP43370Medicare UPIN
WAGAB25042Medicare PIN
WAGAB25043Medicare PIN
WAGAB25044Medicare PIN
WAGAB25041Medicare PIN
WAG8872290Medicare PIN