Provider Demographics
NPI:1134839319
Name:EVERGREEN EYE ANESTHESIA PLLC
Entity type:Organization
Organization Name:EVERGREEN EYE ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ISOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-407-1000
Mailing Address - Street 1:6003 23RD DR W STE 100
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-1583
Mailing Address - Country:US
Mailing Address - Phone:425-407-1500
Mailing Address - Fax:
Practice Address - Street 1:34719 6TH AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8714
Practice Address - Country:US
Practice Address - Phone:800-340-3595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty