Basic Information
| Provider Information | |||||||||
| NPI: | 1215972674 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WASHBURN | ||||||||
| FirstName: | EMMETT | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 N SANTIAM HWY | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973554363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412582101 | ||||||||
| FaxNumber: | 5414517071 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 N SANTIAM HWY | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973554363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412582101 | ||||||||
| FaxNumber: | 5414517071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2006 | ||||||||
| LastUpdateDate: | 02/28/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 095007134 RN/CRNA | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.