Healthcare Provider Details

I. General information

NPI: 1578553418
Provider Name (Legal Business Name): EDGAR FOISY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2005
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 DELAWARE ST
LONGVIEW WA
98632-2367
US

IV. Provider business mailing address

PO BOX 56
BRUSH PRAIRIE WA
98606-0056
US

V. Phone/Fax

Practice location:
  • Phone: 360-414-2000
  • Fax:
Mailing address:
  • Phone: 503-250-0392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number092006540CRNA
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30005612
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: