# AMNESIA LLC

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

## Provider details

- **NPI number:** 1922202688
- **Authorized official:** BROCK M SMITH CRNA, ARNP (OWNER)
- **Authorized official phone:** (360) 753-3516

## Contact information

- **Practice address:** 4717 S 19TH ST, TACOMA, WA 98405-1167
- **Practice address phone:** (253) 761-0861
- **Mailing address:** 3819 100TH ST SW, SUITE 7C, LAKEWOOD, WA 98499-4470
- **Mailing address phone:** (253) 588-7911

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/14/2007
- **Last updated:** 08/22/2020