Organization
PACIFIC NORTHWEST ANESTHESIA SERVICES, INC., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD WILLIAM HERZOG CRNA, ARNP (PRESIDENT)
(360) 908-2457
Entity
Organization
Contact information
Practice address
41487 NE FOULWEATHER BLUFF ROAD, HANSVILLE, WA 98340-0455
(360) 908-2457
(360) 638-0058
Mailing address
PO BOX 455, PO BOX 455, HANSVILLE, WA 98340-0455
(360) 908-2457
(360) 638-0058
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP30002036
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0137504
LABOR AND INDUSTRIES
WA
05
—
9636366
—
WA
01
—
DG0886
RAILROAD MEDICARE
WA
01
—
REGENCE BLUE SHIELD
HE2316
WA
Enumeration date
01/19/2007
Last updated
04/11/2011
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