Healthcare Provider Details

I. General information

NPI: 1669026415
Provider Name (Legal Business Name): SCOTT RAYMOND SINCLAIR CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 E CHICAGO ST
COLDWATER MI
49036-2041
US

IV. Provider business mailing address

5014 IKRAM OAKS
JACKSON MI
49201-7324
US

V. Phone/Fax

Practice location:
  • Phone: 517-279-5400
  • Fax:
Mailing address:
  • Phone: 517-745-3519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704302049
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: