Provider Demographics
NPI:1396933891
Name:GROFFMAN, MARCUS C (CRNA)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:C
Last Name:GROFFMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 E COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-3316
Mailing Address - Country:US
Mailing Address - Phone:509-685-2461
Mailing Address - Fax:509-685-2492
Practice Address - Street 1:982 E COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-3316
Practice Address - Country:US
Practice Address - Phone:509-685-2461
Practice Address - Fax:509-685-2492
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002418367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9638982Medicaid
WAC46597OtherMEDICARE-RAILROAD
WA501326Medicare Oscar/Certification
WAC46597OtherMEDICARE-RAILROAD