Organization
SB SURGICAL ASSISTANT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACI BOTTLES RN (OWNER)
(360) 445-3030
Entity
Organization
Contact information
Practice address
20659 BULSON RD, MOUNT VERNON, WA 98274-8032
(360) 445-3030
Mailing address
PO BOX 803, CONWAY, WA 98238-0803
(360) 445-3003
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
RN00110231
WA
Other
Enumeration date
02/24/2015
Last updated
02/24/2015
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