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General NPI Number Information
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NPI Number | 1780754945
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Entity Type | Organization
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Legal Business Name | UNITED STATES ARMY
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1814 BEACON CT NE
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City | TACOMA
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State | WA
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Zip | 98422-3469
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Country | US
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Telephone | 253-968-0062
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Fax |
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Provider Business Mailing Address
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Address Line | 1814 BEACON CT. NE
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City | TACOMA
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State | WA
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Zip | 98422
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CRNA
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Name | MRS. JENNIFER SAN ROBINSON
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Credential |
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Telephone | 253-376-3558
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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 | 0001167107
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License Number State | VA
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