Healthcare Provider Details

I. General information

NPI: 1154870301
Provider Name (Legal Business Name): JOHN WILLIAMS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MOUNT VERNON AVE
BAKERSFIELD CA
93306-4018
US

IV. Provider business mailing address

471 COLBY CIR
VENTURA CA
93003-3856
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-2000
  • Fax:
Mailing address:
  • Phone: 805-320-1315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number781152
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA95000630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: