Healthcare Provider Details

I. General information

NPI: 1821082496
Provider Name (Legal Business Name): WILLIAM BRUCE MARSHALL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FITZSIMMONS DRIVE BUILDING NUMBER 9040
FORT LEWIS WA
98431
US

IV. Provider business mailing address

5709 71ST AVENUE CT W
UNIVERSITY PLACE WA
98467-4905
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-0062
  • Fax:
Mailing address:
  • Phone: 253-566-1862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN00119501
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: