Healthcare Provider Details

I. General information

NPI: 1982631420
Provider Name (Legal Business Name): JAMES HOWELL YEAGER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROSPECT AVE
SYRACUSE NY
13203-1807
US

IV. Provider business mailing address

PO BOX 650865
DALLAS TX
75265-0865
US

V. Phone/Fax

Practice location:
  • Phone: 315-448-5882
  • Fax:
Mailing address:
  • Phone: 972-715-5000
  • Fax: 972-715-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number598429
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number523744
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: