Provider Demographics
NPI:1346992278
Name:CRISOSTOMO, DAWNRENE' (RN)
Entity Type:Individual
Prefix:MRS
First Name:DAWNRENE'
Middle Name:
Last Name:CRISOSTOMO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 JACKSON BLVD FAMILY MEDICINE CARDINAL/SWAN
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-4126
Mailing Address - Fax:253-968-2826
Practice Address - Street 1:9040 JACKSON BLVD FAMILY MEDICINE CARDINAL/SWAN
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-4126
Practice Address - Fax:253-968-2826
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00128211163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management