Provider Demographics
NPI:1548758733
Name:EMPIRE OF DAFT ANESTHESIA, LLC
Entity Type:Organization
Organization Name:EMPIRE OF DAFT ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KESZLER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
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 1:24622 214TH AVE SE
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8507
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:2018-04-24
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty