Provider Demographics
NPI:1689986747
Name:DOUGLAS G DEMMERT CRNA
Entity Type:Organization
Organization Name:DOUGLAS G DEMMERT CRNA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:DEMMERT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:509-332-4051
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-0487
Mailing Address - Country:US
Mailing Address - Phone:509-332-4051
Mailing Address - Fax:509-332-4051
Practice Address - Street 1:842 S COWLEY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1234
Practice Address - Country:US
Practice Address - Phone:509-755-0927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002486367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9625567Medicaid
WAAB11271Medicare PIN