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Organization

WALLACE ANESTHESIA SERVICES PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GERALD ADRIAN WALLACE CRNA (PRESIDENT)
(503) 372-2740
Entity
Organization

Contact information

Practice address
1253 NW CANAL BLVD, REDMOND, OR 97756-1334
(541) 584-8131
Mailing address
PO BOX 4008, PORTLAND, OR 97208-4008
(503) 372-2740
(503) 372-2754

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary

Other

Enumeration date
06/12/2006
Last updated
08/22/2020
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