MEDICARE: JAMES WESLEY CLAYTON 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	163W00000X	Registered Nurse	407005	CA
2	367500000X	Certified Registered Nurse Anesthetist	2860	CA

General Provider Information

NPI Number	:	1689603185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES WESLEY CLAYTON CRNA

Provider Business Mailing Address
First Line	:	1534 SAVVY CT
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-2337
Country	:	US
Telephone Number	:	415-902-1548
Fax Number	:

Provider Business Practice Location Address
First Line	:	1534 SAVVY CT
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-2337
Country	:	US
Telephone Number	:	415-902-1548
Fax Number	:

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	12/05/2016

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