Healthcare Provider Details

I. General information

NPI: 1699763128
Provider Name (Legal Business Name): JAMES PATRICK SLEPICA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 TOWN CENTER PKWY
RESTON VA
20190-3219
US

IV. Provider business mailing address

PO BOX 67 386 MYRTLE PLACE
OCCOQUAN VA
22125-0067
US

V. Phone/Fax

Practice location:
  • Phone: 703-689-9000
  • Fax:
Mailing address:
  • Phone: 703-497-5826
  • Fax: 703-497-6674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024164541
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: