Organization
ANESTHESIA PUGET SOUND PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS STILLMAN ELSEMORE CRNA (PRESIDENT)
(425) 345-1947
Entity
Organization
Contact information
Practice address
1418 E LAKESHORE DRIVE, LAKE STEVENS, WA 98258
(425) 345-1947
Mailing address
PMB 954, LAKE STEVENS, WA 98258
(425) 345-1947
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP30000995
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430043140
MEDICARE RAILROAD
WA
05
—
9606195
—
VA
01
—
EL3744
REGENCE BLUE SHIELD
WA
Enumeration date
05/04/2007
Last updated
05/06/2008
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