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General NPI Number Information
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NPI Number | 1235282443
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Entity Type | Organization
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Legal Business Name | PACIFIC NORTHWEST ANESTHESIA SERVICES, INC., P.C.
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 41487 NE FOULWEATHER BLUFF ROAD
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City | HANSVILLE
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State | WA
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Zip | 98340-0455
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Country | US
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Telephone | 360-908-2457
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Fax | 360-638-0058
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Provider Business Mailing Address
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Address Line | PO BOX 455 PO BOX 455
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City | HANSVILLE
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State | WA
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Zip | 98340-0455
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Country | US
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Telephone | 360-908-2457
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Fax | 360-638-0058
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Authorized Official
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Title or Position | PRESIDENT
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Name | TODD WILLIAM HERZOG
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Credential | CRNA, ARNP
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Telephone | 360-908-2457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP30002036
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License Number State | WA
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