Provider Demographics
NPI:1265604169
Name:CRANCE, CHERYL (RD, CD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:CRANCE
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 N BROADWAY
Mailing Address - Street 2:PBO
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1409
Mailing Address - Country:US
Mailing Address - Phone:425-317-0264
Mailing Address - Fax:425-317-0291
Practice Address - Street 1:1001 N BROADWAY
Practice Address - Street 2:SUITE A-3
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1586
Practice Address - Country:US
Practice Address - Phone:425-317-0300
Practice Address - Fax:425-317-0303
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00002030132700000X, 133N00000X, 133NN1002X, 133V00000X, 133VN1004X, 133VN1005X, 133VN1006X
ILDI00002030136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADI00002030OtherWASHINGTON STATE LICENSE
WAG8878197Medicare PIN
WAG8872826Medicare PIN