Healthcare Provider Details

I. General information

NPI: 1639128564
Provider Name (Legal Business Name): SIERRA ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 SHERIDAN ST
PT TOWNSEND WA
98368-2443
US

IV. Provider business mailing address

1317 HUMBOLDT ST
BELLINGHAM WA
98225-4931
US

V. Phone/Fax

Practice location:
  • Phone: 877-261-6262
  • Fax: 360-733-9553
Mailing address:
  • Phone: 877-261-6262
  • Fax: 360-733-9553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARC C JOHNSON
Title or Position: CRNA
Credential: CRNA
Phone: 877-261-6262