| Doctor Name: | THOMAS STILLMAN ELSEMORE |
| NPI Number: | 1407832983 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CRNA |
| License Number: | RN00061277 |
| Business Practice Address: | 1418 E Lakeshore Dr Lake Stevens, WA - 982588638 |
| Business Phone Number: | 4253348081 |
| Business Fax Number: | |
| Mailing Address: | Pmb 954, LAKE STEVENS |
| State: | WA |
| Postal Code: | 98258 |
| Phone Number: | 4253451947 |
| Fax Number: | |
| NPI Enumeration Date: | 12/16/2005 |
| NPI Last Update Date: | 01/05/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WX1100X |
| License Number: | RN00061277 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Ophthalmic |
| Taxonomy Definition: | |