Provider Demographics
NPI:1700211786
Name:ADVANCED ANESTHESIA SERVICES, PLLC
Entity Type:Organization
Organization Name:ADVANCED ANESTHESIA SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:425-615-6100
Mailing Address - Street 1:35302 SE CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-9216
Mailing Address - Country:US
Mailing Address - Phone:425-615-6100
Mailing Address - Fax:425-256-3250
Practice Address - Street 1:1260 116TH AVE NE STE 110
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3800
Practice Address - Country:US
Practice Address - Phone:206-330-6722
Practice Address - Fax:425-256-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006926367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty