Basic Information
| Provider Information | |||||||||
| NPI: | 1104166206 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOFFE | ||||||||
| FirstName: | SPENCER | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 406 S 30TH AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099721051 | ||||||||
| FaxNumber: | 5099724166 | ||||||||
| Practice Location | |||||||||
| Address1: | 406 S 30TH AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099721051 | ||||||||
| FaxNumber: | 5099724166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2013 | ||||||||
| LastUpdateDate: | 02/26/2013 | ||||||||
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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 | AP60331329 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.