Provider Demographics
NPI:1568818748
Name:TESTA, MICHAEL (CNOR, RNFA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:TESTA
Suffix:
Gender:M
Credentials:CNOR, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1371
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-1371
Mailing Address - Country:US
Mailing Address - Phone:360-981-5890
Mailing Address - Fax:
Practice Address - Street 1:17005 SCANDIA CT NW
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8154
Practice Address - Country:US
Practice Address - Phone:360-981-5890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60389466163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1657919OtherCERTIFIED NURSE OPERATING ROOM (CNOR)