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General NPI Number Information
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NPI Number | 1366077745
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Entity Type | Individual
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Provider Name | ANDREW J MAASDAM CRNA
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Gender | Male
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Dates
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Enumeration Date | 03/06/2020
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Last Update Date | 03/06/2020
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Provider Practice Location Address
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Address Line | 914 S SCHEUBER RD
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City | CENTRALIA
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State | WA
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Zip | 98531-9027
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Country | US
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Telephone | 360-736-2803
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Fax |
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Provider Business Mailing Address
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Address Line | 2224 N 51ST ST
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City | OMAHA
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State | NE
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Zip | 68104-4337
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Country | US
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Telephone | 402-212-6962
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 61035689
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License Number State | WA
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