# MV-ANESTHESIA PS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154457281
- **Authorized official:** TERRILYNN NICKLIN (BILLING MANAGER)
- **Authorized official phone:** (360) 434-3009

## Contact information

- **Practice address:** 110 N 30TH ST, MOUNT VERNON, WA 98273-3668
- **Practice address phone:** (360) 434-3009
- **Practice address fax:** (360) 895-5380
- **Mailing address:** PO BOX 11810, BAINBRIDGE ISLAND, WA 98110-5810
- **Mailing address phone:** (360) 434-3009
- **Mailing address fax:** (360) 895-5380

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | MD00033163 | WA | Yes |

## Other

- **Enumeration date:** 02/25/2007
- **Last updated:** 06/26/2008