Individual
MR. MARK R HOLMBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.R.N.A.
Contact information
Practice address
1100 9TH AVE, SEATTLE, WA 98101-2756
(206) 223-6980
(206) 223-6982
Mailing address
2415 WESTERN AVE, APT 503, SEATTLE, WA 98121-1394
(612) 741-5259
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP30007744
WA
367500000X
Certified Registered Nurse Anesthetist
R 154503-0
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5069HO
BLUE SHIELD #
WA
05
—
9653981
—
WA
01
—
P00444040
RAILROAD MC #
WA
01
—
RNA0011
ALASKA DSHS
WA
Enumeration date
01/05/2006
Last updated
03/12/2015
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