Provider Demographics
NPI:1417994377
Name:MILDES, ROBERT ALLEN (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:MILDES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 212TH PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-8606
Mailing Address - Country:US
Mailing Address - Phone:425-672-7275
Mailing Address - Fax:425-744-0117
Practice Address - Street 1:708 212TH PL SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-8606
Practice Address - Country:US
Practice Address - Phone:425-672-7275
Practice Address - Fax:425-744-0117
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA025804 30004423367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8866266Medicare PIN
WAG8866265Medicare PIN