Provider Demographics
NPI:1295099380
Name:EWANOWICH, DONNA LEANNE (CRNA)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:LEANNE
Last Name:EWANOWICH
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 1:1100 9TH AVE
Mailing Address - Street 2:MS:M4-PFS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:MS:M4-PFS
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-515-5811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00120850163W00000X
AZRN076386163W00000X
LARN091720163W00000X
MARN209836163W00000X
MN187422-2163W00000X
NH037923-21163W00000X
SC55791163W00000X
TX567161163W00000X
WI132181163W00000X
CA544776163W00000X
WAAP60302473367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0299285OtherLABOR & INDUSTRY
WA1295099380Medicaid
WA1295099380Medicaid