Healthcare Provider Details

I. General information

NPI: 1699786368
Provider Name (Legal Business Name): JAMES ALLAN KROLL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 116TH AVE NE
BELLVUE WA
98004
US

IV. Provider business mailing address

2029 161ST AVE NE
SNOKOMISH WA
98290-7771
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-5133
  • Fax:
Mailing address:
  • Phone: 206-654-9025
  • Fax: 475-397-8257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30004363
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: