Healthcare Provider Details

I. General information

NPI: 1497740278
Provider Name (Legal Business Name): JAMES M SLATTERY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 BERTHA HOWE AVE
MESQUITE NV
89027-7500
US

IV. Provider business mailing address

PO BOX 3540
MESQUITE NV
89024-3540
US

V. Phone/Fax

Practice location:
  • Phone: 800-277-8151
  • Fax:
Mailing address:
  • Phone: 800-277-8151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA000253
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: