Healthcare Provider Details

I. General information

NPI: 1386143303
Provider Name (Legal Business Name): ERIC STEVENSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 BROADWAY
SEATTLE WA
98122-4379
US

IV. Provider business mailing address

1229 MADISON ST STE 1440
SEATTLE WA
98104-3538
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-2550
  • Fax:
Mailing address:
  • Phone: 206-625-0578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number113064
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: