Organization
AMNESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROCK M SMITH CRNA, ARNP (OWNER)
(360) 753-3516
Entity
Organization
Contact information
Practice address
4717 S 19TH ST, TACOMA, WA 98405-1167
(253) 761-0861
Mailing address
3819 100TH ST SW, SUITE 7C, LAKEWOOD, WA 98499-4470
(253) 588-7911
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9652017
—
WA
Enumeration date
06/14/2007
Last updated
08/22/2020
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