Provider Demographics
NPI:1376243642
Name:QUEST KETAMINE THERAPIES PLLC
Entity Type:Organization
Organization Name:QUEST KETAMINE THERAPIES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KESZLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-245-7552
Mailing Address - Street 1:24622 214TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-8507
Mailing Address - Country:US
Mailing Address - Phone:206-245-7552
Mailing Address - Fax:
Practice Address - Street 1:22525 SE 64TH PL
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5383
Practice Address - Country:US
Practice Address - Phone:206-245-7552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty