Individual
MR. WILLIAM G CHISHOLM JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
174 1ST AVE N, ILWACO, WA 98624-9137
(360) 642-3181
Mailing address
91 E TAMARACK LN, SHELTON, WA 98584-9402
(360) 427-5747
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP30001327
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
210785
—
OR
01
—
430073112
MEDICARE RAILROAD
WA
05
—
9603887
—
WA
Enumeration date
07/03/2006
Last updated
02/02/2016
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