Provider Demographics
NPI:1861547200
Name:PLATEAU ANESTHESIA PS
Entity type:Organization
Organization Name:PLATEAU ANESTHESIA PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:360-802-3243
Mailing Address - Street 1:1450 BATTERSBY AVE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-3634
Mailing Address - Country:US
Mailing Address - Phone:360-802-3243
Mailing Address - Fax:360-802-3237
Practice Address - Street 1:1450 BATTERSBY AVE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3634
Practice Address - Country:US
Practice Address - Phone:360-802-3243
Practice Address - Fax:360-802-3237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7092034Medicaid
WA0121788OtherLABOR & INDUSTRIES
WA601 854 264OtherUNIFIED BUSINESS ID
WA601 854 264OtherUNIFIED BUSINESS ID