# SB SURGICAL ASSISTANT, LLC

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

## Provider details

- **NPI number:** 1437541620
- **Authorized official:** STACI BOTTLES RN (OWNER)
- **Authorized official phone:** (360) 445-3030

## Contact information

- **Practice address:** 20659 BULSON RD, MOUNT VERNON, WA 98274-8032
- **Practice address phone:** (360) 445-3030
- **Mailing address:** PO BOX 803, CONWAY, WA 98238-0803
- **Mailing address phone:** (360) 445-3003

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WR0006X | Registered Nurse First Assistant | RN00110231 | WA | Yes |

## Other

- **Enumeration date:** 02/24/2015
- **Last updated:** 02/24/2015