Healthcare Provider Details

I. General information

NPI: 1437111663
Provider Name (Legal Business Name): JANICE IRENE MAY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 HOSPITAL WAY
BREWSTER WA
98812-0577
US

IV. Provider business mailing address

PO BOX 577 507 HOSPITAL WAY
BREWSTER WA
98812-0577
US

V. Phone/Fax

Practice location:
  • Phone: 509-689-2517
  • Fax: 509-689-2086
Mailing address:
  • Phone: 509-689-2517
  • Fax: 509-689-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30005355
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: