MEDICARE: JAMES STIMPSON CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	4758542-4406	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	49108	OTHER	UT	HEALTHY U
2	190246100	OTHER	UT	DEPT OF LABOR
3	68295	OTHER	UT	PEHP
4	218518	OTHER	UT	ALTIUS

General Provider Information

NPI Number	:	1538272372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES STIMPSON CRNA

Provider Business Mailing Address
First Line	:	3765 S 3650 W
Second Line	:
City	:	WEST HAVEN
State	:	UT
Zip	:	84401-9373
Country	:	US
Telephone Number	:	801-731-0173
Fax Number	:

Provider Business Practice Location Address
First Line	:	3765 S 3650 W
Second Line	:
City	:	WEST HAVEN
State	:	UT
Zip	:	84401-9373
Country	:	US
Telephone Number	:	801-791-9566
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	10/20/2009

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