Individual
MR. MARK ANDREYEVICH BOBROVNIKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
914 S SCHEUBER RD, CENTRALIA, WA 98531-9027
(360) 736-2803
Mailing address
6400 SE LAKE RD STE 300, PORTLAND, OR 97222-2129
(503) 594-1774
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
266874
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
AP70080711
WA
Other
Enumeration date
10/24/2022
Last updated
01/12/2026
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