Provider Demographics
NPI:1578806097
Name:CRONQUIST, MICHAEL DEWAYNE (FNPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DEWAYNE
Last Name:CRONQUIST
Suffix:
Gender:M
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17110 E DAYBREAK LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-8767
Mailing Address - Country:US
Mailing Address - Phone:509-991-2545
Mailing Address - Fax:509-420-9294
Practice Address - Street 1:17110 E DAYBREAK LN
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99016-8767
Practice Address - Country:US
Practice Address - Phone:509-475-1347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 60324274363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily