Healthcare Provider Details

I. General information

NPI: 1063787836
Provider Name (Legal Business Name): BRACAN JOHN WILLIAMS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12833 51ST AVE SE
EVERETT WA
98208-9618
US

IV. Provider business mailing address

12833 51ST AVE SE
EVERETT WA
98208-9618
US

V. Phone/Fax

Practice location:
  • Phone: 206-919-5082
  • Fax:
Mailing address:
  • Phone: 206-919-5082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201142666RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP60499120
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: