Provider Demographics
NPI:1952671612
Name:HERBST, JAMES PETER III (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:PETER
Last Name:HERBST
Suffix:III
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:100 BREWSTER BLVD
Mailing Address - Street 2:NAVAL HOSPITAL
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547-2538
Mailing Address - Country:US
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Practice Address - Street 1:100 BREWSTER BLVD
Practice Address - Street 2:NAVAL HOSPITAL
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2538
Practice Address - Country:US
Practice Address - Phone:910-450-4159
Practice Address - Fax:910-450-4194
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-02-27
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Provider Licenses
StateLicense IDTaxonomies
VA0001196408367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered