Healthcare Provider Details

I. General information

NPI: 1396350765
Provider Name (Legal Business Name): CMN SURGICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2020
Last Update Date: 09/13/2020
Certification Date: 09/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 LILLY RD NE STE 101
OLYMPIA WA
98506-5028
US

IV. Provider business mailing address

145 LILLY RD NE STE 101
OLYMPIA WA
98506-5028
US

V. Phone/Fax

Practice location:
  • Phone: 360-878-9300
  • Fax: 360-878-9666
Mailing address:
  • Phone: 360-878-9300
  • Fax: 360-878-9666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER M NICHOLS
Title or Position: OWNER
Credential: MD
Phone: 360-878-9300