Individual
THEODORE RUSSELL GAVEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
914 S SCHEUBER RD, PMG SW WA CENTRALIA ANESTHESIOLOGY, CENTRALIA, WA 98531-9027
(360) 736-2803
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP60443744
WA
367500000X
Certified Registered Nurse Anesthetist
RN584062
PA
Other
Enumeration date
05/19/2010
Last updated
05/21/2014
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