Organization
GENESIS ANESTHESIA SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD F CESSNA JR. CRNA (PROVIDER/OWNER)
(253) 588-7911
Entity
Organization
Contact information
Practice address
2100 LITTLE MOUNTAIN LN, MOUNT VERNON, WA 98274-8752
(253) 588-7911
(253) 984-6774
Mailing address
PO BOX 97115, LAKEWOOD, WA 98497-0115
(253) 588-7911
(253) 984-6774
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN516520L
PA
163W00000X
Registered Nurse
RN60124881
WA
367500000X
Certified Registered Nurse Anesthetist
Primary
60130625
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60130625
STATE LICENSE
WA
01
—
RN60124881
REGISTERED NURSE LICENSE
WA
Enumeration date
02/24/2010
Last updated
02/24/2010
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