Provider Demographics
NPI:1255519021
Name:FOLLIS, ALLEN J (CRNA)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:J
Last Name:FOLLIS
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:PO BOX 2329
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-7329
Mailing Address - Country:US
Mailing Address - Phone:360-466-2542
Mailing Address - Fax:
Practice Address - Street 1:212 S 92ND AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-9361
Practice Address - Country:US
Practice Address - Phone:509-972-1051
Practice Address - Fax:509-972-4166
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30008031367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered