Provider Demographics
NPI:1104868751
Name:KRANICK, EIRENE SARAH (FNP)
Entity type:Individual
Prefix:
First Name:EIRENE
Middle Name:SARAH
Last Name:KRANICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:EIRENE
Other - Middle Name:
Other - Last Name:BEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6332 MT BAKER HWY
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:WA
Mailing Address - Zip Code:98244-9547
Mailing Address - Country:US
Mailing Address - Phone:425-344-8123
Mailing Address - Fax:
Practice Address - Street 1:4462 BOB SCHULTZ RD
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WA
Practice Address - Zip Code:99111-8683
Practice Address - Country:US
Practice Address - Phone:425-344-8123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP30007312OtherSTATE LICENSE NUMBER
WAAP30007312OtherSTATE LICENSE NUMBER