Healthcare Provider Details

I. General information

NPI: 1992926380
Provider Name (Legal Business Name): FREDRICK L MASTERS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 S SCHEUBER RD
CENTRALIA WA
98531-9027
US

IV. Provider business mailing address

909 N BROADWAY
EVERETT WA
98201-1409
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-2803
  • Fax: 360-330-8970
Mailing address:
  • Phone: 425-317-0246
  • Fax: 425-317-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30004440
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: