Healthcare Provider Details

I. General information

NPI: 1356694244
Provider Name (Legal Business Name): JAMES CARLTON PRINCE III CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 MADISON ST STE 1440
SEATTLE WA
98104-3538
US

IV. Provider business mailing address

1229 MADISON ST STE 1440
SEATTLE WA
98104-3538
US

V. Phone/Fax

Practice location:
  • Phone: 206-625-0578
  • Fax: 206-625-9184
Mailing address:
  • Phone: 206-625-0578
  • Fax: 206-625-9184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9236268
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2282711
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2282711
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP60616023
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: