Individual
BROCK J AMOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2367
(360) 414-2000
(360) 414-7638
Mailing address
1115 SE 164TH AVE, DEPT. 358, VANCOUVER, WA 98683-9324
(360) 729-1462
(360) 729-3104
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP60410232
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2038923
—
WA
05
—
G8937842
—
OR
Enumeration date
11/14/2006
Last updated
02/15/2016
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