Healthcare Provider Details

I. General information

NPI: 1316009483
Provider Name (Legal Business Name): DONNA PAULEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 COOKS HILL RD.
CENTRALIA WA
98531
US

IV. Provider business mailing address

2940 W MARINE VIEW DR
EVERETT WA
98201-3926
US

V. Phone/Fax

Practice location:
  • Phone: 360-943-8470
  • Fax:
Mailing address:
  • Phone: 425-258-7014
  • Fax: 425-258-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30004373
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: