Provider Demographics
NPI:1346401833
Name:CLINE, ROBERT MATT (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MATT
Last Name:CLINE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 S 23RD ST STE 340
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1602
Mailing Address - Country:US
Mailing Address - Phone:253-503-2598
Mailing Address - Fax:253-404-0506
Practice Address - Street 1:3209S 23RD ST 340
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1602
Practice Address - Country:US
Practice Address - Phone:253-503-2598
Practice Address - Fax:253-404-0506
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60524188367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8053236Medicaid
WAG8944391OtherMDCR PTAN (K)
WAG8960778OtherMDCR PTAN (P)
SCNAN849Medicaid
NC8053236Medicaid
WAG8885529Medicare PIN