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General NPI Number Information
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NPI Number | 1801858535
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Entity Type | Individual
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Provider Name | ALLYN D. WILCOCK CRNA
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Gender | Male
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 7829 CENTER BLVE STE 310
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City | SNOQUALMIE
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State | WA
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Zip | 98065
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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 | 36410 SE ISLEY ST
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City | SNOQUALMIE
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State | WA
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Zip | 98065-8983
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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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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN00157281
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License Number State | WA
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Taxonomy #2
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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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