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General NPI Number Information
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NPI Number | 1003878471
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Entity Type | Organization
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Legal Business Name | MASON COUNTY ANESTHESIA SERVICES PLLC
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 901 MT VIEW DR BLDG 1
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City | SHELTON
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State | WA
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Zip | 98584-4401
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Country | US
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Telephone | 360-426-1611
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Fax |
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Provider Business Mailing Address
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Address Line | 400 E 10TH ST
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City | WACONIA
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State | MN
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Zip | 55387-4552
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Country | US
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Telephone | 952-442-9770
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Fax | 952-442-3630
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEBORAH HARTLEY
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Credential | CRNA
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Telephone | 360-427-3625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State | WA
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