Healthcare Provider Details

I. General information

NPI: 1336137173
Provider Name (Legal Business Name): JAMES WOELK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W SPENCER AVE STE B
GUNNISON CO
81230-2546
US

IV. Provider business mailing address

PO BOX 668
ARVADA CO
80001-0668
US

V. Phone/Fax

Practice location:
  • Phone: 303-422-9438
  • Fax:
Mailing address:
  • Phone: 303-422-9438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number55574
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number64320
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: