Provider Demographics
NPI:1346493863
Name:CROGAN, JOHANNAH HENSEL (PNP)
Entity Type:Individual
Prefix:
First Name:JOHANNAH
Middle Name:HENSEL
Last Name:CROGAN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N 44TH ST
Mailing Address - Street 2:APT 2
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7440
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 N 44TH ST
Practice Address - Street 2:APT 2
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7440
Practice Address - Country:US
Practice Address - Phone:425-239-6772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA278053363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics