MEDICARE: ALLYN D. WILCOCK CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN00157281	WA
2	367500000X	Certified Registered Nurse Anesthetist	AP30006926	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8940597	OTHER	WA	L & I CRIME VICTIMS
2	52822U	OTHER	WA	REGENCE BLUESHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0197111	OTHER	WA	LABOR & INDUSTRY

General Provider Information

NPI Number	:	1801858535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYN D. WILCOCK CRNA

Provider Business Mailing Address
First Line	:	36410 SE ISLEY ST
Second Line	:
City	:	SNOQUALMIE
State	:	WA
Zip	:	98065-8983
Country	:	US
Telephone Number	:	206-330-6722
Fax Number	:	425-256-3250

Provider Business Practice Location Address
First Line	:	7829 CENTER BLVE STE 310
Second Line	:
City	:	SNOQUALMIE
State	:	WA
Zip	:	98065
Country	:	US
Telephone Number	:	206-330-6722
Fax Number	:	425-256-3250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	02/14/2017

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