Healthcare Provider Details

I. General information

NPI: 1588100044
Provider Name (Legal Business Name): JIMMIE WAYNE SEELEY III CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 W 2ND PL
LAKEWOOD CO
80228-1527
US

IV. Provider business mailing address

520 GOLDEN RIDGE RD APT 302
GOLDEN CO
80401-8905
US

V. Phone/Fax

Practice location:
  • Phone: 239-304-6585
  • Fax:
Mailing address:
  • Phone: 239-304-6585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN.0992967-CRNA
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: