Provider Demographics
NPI:1750612917
Name:NEKHAMIS, MIKHAIL PAVLOVICH (CRNA)
Entity type:Individual
Prefix:MR
First Name:MIKHAIL
Middle Name:PAVLOVICH
Last Name:NEKHAMIS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:360-486-6508
Mailing Address - Fax:
Practice Address - Street 1:914 S SCHEUBER RD
Practice Address - Street 2:PMG SW WA CENTRALIA ANESTHESIOLOGY
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9027
Practice Address - Country:US
Practice Address - Phone:360-330-8501
Practice Address - Fax:360-330-8690
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2024-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAAP60139268367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN00138262OtherLICENSE
WAAP60139268OtherLICENSE