Healthcare Provider Details

I. General information

NPI: 1871512244
Provider Name (Legal Business Name): JAMES DANIL GLENN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 SW 9TH AVENUE
ALBANY OR
97321
US

IV. Provider business mailing address

PO BOX 301558
DALLAS TX
75303-1558
US

V. Phone/Fax

Practice location:
  • Phone: 541-926-9611
  • Fax: 541-926-6152
Mailing address:
  • Phone: 866-847-5072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number098007052CRNA
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: