Provider Demographics
NPI:1558303297
Name:HARE, MARCI (CRNA)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:HARE
Suffix:
Gender:F
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:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:2205 NE 129TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3252
Practice Address - Country:US
Practice Address - Phone:360-694-2544
Practice Address - Fax:360-694-1356
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX700259367500000X
OR095006239RN367500000X
WARN00168011367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1558303297Medicaid
WA1013127Medicaid
WAG895792OtherMEDICARE WA