Healthcare Provider Details

I. General information

NPI: 1295741650
Provider Name (Legal Business Name): JAMES WILSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 OLD LANCASTER RD STE 330
BRYN MAWR PA
19010-3235
US

IV. Provider business mailing address

825 OLD LANCASTER RD STE 320
BRYN MAWR PA
19010-3235
US

V. Phone/Fax

Practice location:
  • Phone: 484-380-2880
  • Fax: 610-672-0302
Mailing address:
  • Phone: 610-527-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NR09354100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL6-0A00714
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN318428L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: