Healthcare Provider Details

I. General information

NPI: 1487702767
Provider Name (Legal Business Name): JAMES ROBERT TROY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S VAN DYKE RD
BAD AXE MI
48413-9615
US

IV. Provider business mailing address

17 MARCY LN
LOGANSPORT IN
46947-2400
US

V. Phone/Fax

Practice location:
  • Phone: 989-269-9521
  • Fax:
Mailing address:
  • Phone: 574-739-0189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: