Individual ProviderMark R HolmbergNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1100 9th Ave, Seattle, WA 98101-2756(206) 223-6980(612) 741-5259PECOS EnrollmentBased on the most recent information from CMS, provider Mark R Holmberg does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1790763233Provider TypeIndividualFull NameHolmberg, Mark RTitleMr.CredentialC.R.N.A.GenderMaleSole ProprietorNoEnumeration Date1/5/2006Last Updated3/12/2015Contact InformationPractice LocationPractice Address1100 9th Ave, Seattle, WA 98101-2756Phone(206) 223-6980Fax(206) 223-6982Mailing LocationMailing Address2415 Western Ave, Apt 503, Seattle, WA 98121-1394Phone(612) 741-5259FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode367500000XPrimaryDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicenseAP30007744WashingtonCode367500000XDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicenseR 154503-0MinnesotaProvider IdentifiersIDDescriptionIssuerID5069HODescriptionOtherIssuerBLUE SHIELD #WashingtonIDRNA0011DescriptionOtherIssuerALASKA DSHSWashingtonIDP00444040DescriptionOtherIssuerRAILROAD MC #WashingtonID9653981DescriptionMedicaidIssuerUnlistedWashington