Basic Information
| Provider Information | |||||||||
| NPI: | 1295099380 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EWANOWICH | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | LEANNE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 9TH AVE | ||||||||
| Address2: | MS:M4-PFS | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981012756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065155811 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1100 9TH AVE | ||||||||
| Address2: | MS:M4-PFS | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981012756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065155811 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2012 | ||||||||
| LastUpdateDate: | 04/24/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN00120850 | WA | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN076386 | AZ | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN091720 | LA | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN209836 | MA | N | Nursing Service Providers | Registered Nurse | 163W00000X | 187422-2 | MN | N | Nursing Service Providers | Registered Nurse | 163W00000X | 037923-21 | NH | N | Nursing Service Providers | Registered Nurse | 163W00000X | 55791 | SC | N | Nursing Service Providers | Registered Nurse | 163W00000X | 567161 | TX | N | Nursing Service Providers | Registered Nurse | 163W00000X | 132181 | WI | N | Nursing Service Providers | Registered Nurse | 163W00000X | 544776 | CA | N | Nursing Service Providers | Registered Nurse | 367500000X | AP60302473 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 0299285 | 01 | WA | LABOR & INDUSTRY | OTHER | 1295099380 | 05 | WA | MEDICAID |