Individual
OWEN STAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
9040 JACKSON AVE, TACOMA, WA 98431-0001
(253) 968-0959
Mailing address
9040 JACKSON AVE, TACOMA, WA 98431-0001
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
5665237-4406
UT
Other
Enumeration date
07/01/2016
Last updated
07/05/2016
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