Provider Demographics
NPI:1457892291
Name:PROFESSIONAL REGISTRY OF NURSING, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL REGISTRY OF NURSING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-617-7715
Mailing Address - Street 1:10828 GRAVELLY LAKE DR SW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1334
Mailing Address - Country:US
Mailing Address - Phone:253-617-7715
Mailing Address - Fax:253-589-1514
Practice Address - Street 1:10828 GRAVELLY LAKE DR SW
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1334
Practice Address - Country:US
Practice Address - Phone:253-617-7715
Practice Address - Fax:253-589-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANPOL.NR.00000237251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care