Provider Demographics
NPI:1871512244
Name:GLENN, JAMES DANIL (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DANIL
Last Name:GLENN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 301558
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75303-1558
Mailing Address - Country:US
Mailing Address - Phone:866-847-5072
Mailing Address - Fax:
Practice Address - Street 1:930 SW 9TH AVENUE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321
Practice Address - Country:US
Practice Address - Phone:541-926-9611
Practice Address - Fax:541-926-6152
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR098007052CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213482Medicaid
OR103712Medicare ID - Type Unspecified
ORS20204Medicare UPIN