Provider Demographics
NPI:1669417614
Name:STEEN, ALAN (CRNA)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:STEEN
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 1:723 MEMORIAL ST
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-1524
Mailing Address - Country:US
Mailing Address - Phone:509-786-2222
Mailing Address - Fax:509-786-6612
Practice Address - Street 1:723 MEMORIAL ST
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-1524
Practice Address - Country:US
Practice Address - Phone:509-786-2222
Practice Address - Fax:509-786-6612
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004864367500000X
WARN00065080367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1306897681OtherPROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
WA0165690OtherLABOR AND INDUSTRIES #
WA9606799Medicaid
WA01944OtherPMH GROUP L & I #
WA0165690OtherLABOR AND INDUSTRIES #
WA000381261Medicare ID - Type UnspecifiedMEDICARE PROVIDER #