Provider Demographics
NPI:1962738781
Name:WUERDEMAN, EMILY D (CRNA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:D
Last Name:WUERDEMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 N ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-6814
Mailing Address - Country:US
Mailing Address - Phone:731-796-0407
Mailing Address - Fax:
Practice Address - Street 1:3209S 23RD ST 340
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1602
Practice Address - Country:US
Practice Address - Phone:253-503-2598
Practice Address - Fax:253-404-0506
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN150796367500000X
WAAP60577045367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8944647OtherMDCR PTAN (K)
WAG8944647OtherMDCR PTAN (K)