Healthcare Provider Details

I. General information

NPI: 1699794545
Provider Name (Legal Business Name): JAMES RALPH APPLETON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 CHURCH ST N
CONCORD NC
28025-2927
US

IV. Provider business mailing address

5701 REBEL DR
CHARLOTTE NC
28210-6439
US

V. Phone/Fax

Practice location:
  • Phone: 704-783-4235
  • Fax: 704-783-2527
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number54517
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: