Provider Demographics
NPI:1255548681
Name:SPRING, ROXANNE (CNM)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:SPRING
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10814 W LAKE JOY DR NE
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-6808
Mailing Address - Country:US
Mailing Address - Phone:425-788-4629
Mailing Address - Fax:
Practice Address - Street 1:3225 HOSPITAL DR
Practice Address - Street 2:SUITE 106
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7863
Practice Address - Country:US
Practice Address - Phone:907-586-1203
Practice Address - Fax:907-586-5765
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004783363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP30004783OtherARNP LICENSE
WARN00114703OtherLICENSE