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General NPI Number Information
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NPI Number | 1578821468
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Entity Type | Individual
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Provider Name | JAMES NICKLESON CRNA
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Gender | Male
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 05/06/2026
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Provider Practice Location Address
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Address Line | 101 W 8TH AVE DEPT OF ANESTHESIA
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City | SPOKANE
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State | WA
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Zip | 99204
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Country | US
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Telephone | 509-474-4971
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Fax |
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Provider Business Mailing Address
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Address Line | 16622 N CINCINNATI CT
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City | SPOKANE
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State | WA
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Zip | 99208-7511
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Country | US
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Telephone | 509-389-5900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP 60288624
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN00122408
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP 60288624
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License Number State | WA
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