Healthcare Provider Details

I. General information

NPI: 1841275773
Provider Name (Legal Business Name): RICHARD JAMES BROWN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20502 NE 190TH CIR
BRUSH PRAIRIE WA
98606-8813
US

IV. Provider business mailing address

20502 NE 190TH CIR
BRUSH PRAIRIE WA
98606-8813
US

V. Phone/Fax

Practice location:
  • Phone: 360-601-6991
  • Fax:
Mailing address:
  • Phone: 360-601-6991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number200560009CRNA
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30006990
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number36575
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: