Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Other names
PLASTIC & RECONSTRUCTIVE SURGEONS
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURA KLEISLE (CHIEF RISK OFFICER)
(206) 838-2590
Entity
Organization
Contact information
Practice address
17930 TALBOT RD S, RENTON, WA 98055-6230
(425) 228-3187
(425) 228-7972
Mailing address
17930 TALBOT RD S, RENTON, WA 98055-6230
(425) 228-3187
(204) 228-7972
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
601484763
WA
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2036917
—
WA
01
—
326119
WA L&I
WA
Enumeration date
04/25/2014
Last updated
07/28/2022
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