Healthcare Provider Details

I. General information

NPI: 1356345185
Provider Name (Legal Business Name): JOHN E BUONORA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 01/08/2022
Certification Date: 01/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-4933
US

IV. Provider business mailing address

10901 102ND AVE SW
LAKEWOOD WA
98498-2909
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-0554
  • Fax: 253-986-3278
Mailing address:
  • Phone: 240-429-8870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number133435-030
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP60879305
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: