Provider Demographics
NPI:1881848653
Name:KROHA, EDITH TRITES (ARNP)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:TRITES
Last Name:KROHA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 YAKIMA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5307
Mailing Address - Country:US
Mailing Address - Phone:253-426-4420
Mailing Address - Fax:253-426-4383
Practice Address - Street 1:1708 YAKIMA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5307
Practice Address - Country:US
Practice Address - Phone:253-426-4420
Practice Address - Fax:253-426-4383
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60045369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9659863Medicaid
WA0243565OtherL & I
WA0243567OtherL & I
WA8949783OtherCRIME VICTIMS
WAG8877724OtherMEDICARE
WAP00846069OtherRAILROAD
WAG8877706OtherMEDICARE
WA0243569OtherL & I