Provider Demographics
NPI:1790980092
Name:DARCEY, MARK B (CRNA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:B
Last Name:DARCEY
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 1:732 SUMMITVIEW AVE
Mailing Address - Street 2:#621
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3032
Mailing Address - Country:US
Mailing Address - Phone:509-573-3448
Mailing Address - Fax:509-574-4481
Practice Address - Street 1:110 S 9TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3315
Practice Address - Country:US
Practice Address - Phone:509-576-3721
Practice Address - Fax:509-574-4481
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007767367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9653023Medicaid
WA9653023Medicaid