Provider Demographics
NPI:1912731233
Name:CROSBY, JANIS MATRONA (RN)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:MATRONA
Last Name:CROSBY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30526 SE LAKE RETREAT SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:RAVENSDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98051-9526
Mailing Address - Country:US
Mailing Address - Phone:425-417-8525
Mailing Address - Fax:
Practice Address - Street 1:30526 SE LAKE RETREAT SOUTH DR
Practice Address - Street 2:
Practice Address - City:RAVENSDALE
Practice Address - State:WA
Practice Address - Zip Code:98051-9526
Practice Address - Country:US
Practice Address - Phone:425-417-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00053451163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse