Organization
MASON COUNTY ANESTHESIA SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH HARTLEY CRNA (PRESIDENT)
(360) 427-3625
Entity
Organization
Contact information
Practice address
901 MT VIEW DR, BLDG 1, SHELTON, WA 98584-4401
(360) 426-1611
Mailing address
400 E 10TH ST, WACONIA, MN 55387-4552
(952) 442-9770
(952) 442-3630
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0128180
DEPT OF LABOR & INDUSTRY
WA
05
—
7096241
—
WA
01
—
8934002
CRIME VICTIM COMP PROGRAM
WA
Enumeration date
04/03/2006
Last updated
04/29/2008
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