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General NPI Number Information
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NPI Number | 1700211786
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Entity Type | Organization
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Legal Business Name | ADVANCED ANESTHESIA SERVICES, PLLC
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Dates
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Enumeration Date | 09/09/2013
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 1260 116TH AVE NE STE 110
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City | BELLEVUE
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State | WA
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Zip | 98004-3800
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Country | US
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Telephone | 206-330-6722
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Fax | 425-256-3250
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Provider Business Mailing Address
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Address Line | 35302 SE CENTER ST
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City | SNOQUALMIE
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State | WA
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Zip | 98065-9216
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Country | US
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Telephone | 425-615-6100
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Fax | 425-256-3250
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Authorized Official
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Title or Position | OWNER
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Name | ALLYN D. WILCOCK
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Credential | CRNA
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Telephone | 425-615-6100
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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 | AP30006926
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License Number State | WA
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