Individual
THOMAS STILLMAN ELSEMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1418 E LAKESHORE DR, LAKE STEVENS, WA 98258-8638
(425) 334-8081
Mailing address
PMB 954, LAKE STEVENS, WA 98258
(425) 345-1947
Taxonomy
Speciality
Code
Description
License number
State
163WX1100X
Ophthalmic Registered Nurse
Primary
RN00061277
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202723
L & I
WA
05
—
9618489
—
WA
Enumeration date
12/16/2005
Last updated
01/05/2010
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