Provider Demographics
NPI:1063521235
Name:PALENSHUS, ANN LOEFFLER (CRNA)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:LOEFFLER
Last Name:PALENSHUS
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 1:17111 NW 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-9030
Mailing Address - Country:US
Mailing Address - Phone:360-989-4077
Mailing Address - Fax:
Practice Address - Street 1:17111 NW 69TH AVE
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-9030
Practice Address - Country:US
Practice Address - Phone:360-989-4077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR096006546367500000X
TX245585367500000X
SC19775367500000X
WAAP30003999367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered