Healthcare Provider Details

I. General information

NPI: 1497841993
Provider Name (Legal Business Name): JAMES P ROSWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26031 SE 192 ST
MAPLE VALLEY WA
98038
US

IV. Provider business mailing address

26031 SE 192 ST
MAPLE VALLEY WA
98038
US

V. Phone/Fax

Practice location:
  • Phone: 425-413-0491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: