Provider Demographics
NPI:1548712680
Name:ANESTHESIA ELEMENTS
Entity type:Organization
Organization Name:ANESTHESIA ELEMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEUDIEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:PUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:425-213-9915
Mailing Address - Street 1:26323 NE 25TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-9081
Mailing Address - Country:US
Mailing Address - Phone:425-213-9915
Mailing Address - Fax:
Practice Address - Street 1:26323 NE 25TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-9081
Practice Address - Country:US
Practice Address - Phone:425-213-9915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006800367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty