Provider Demographics
NPI:1689668154
Name:MACKENZIE, IAN ANGUS (CRNA)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:ANGUS
Last Name:MACKENZIE
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 1:1100 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6980
Practice Address - Fax:206-223-6982
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT45344367500000X, 163W00000X
WARN00103282163W00000X
CARN 466027163W00000X
MNR147063-9163W00000X
WAAP30005404367500000X
CANA 2224367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9632951Medicaid
WA0292055OtherLABOR AND INDUSTRY
WAP01169721OtherRAILROAD MEDICARE
WA0292055OtherLABOR AND INDUSTRY
WAAB25882Medicare PIN