Provider Demographics
NPI:1669420568
Name:ADAMS, JEREMY T (CRNA)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:T
Last Name:ADAMS
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 4189
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-4189
Mailing Address - Country:US
Mailing Address - Phone:530-990-5889
Mailing Address - Fax:
Practice Address - Street 1:1135 116TH AVE NE STE 570
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4632
Practice Address - Country:US
Practice Address - Phone:253-797-4908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61053308163W00000X
WAAP61054516367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00148619OtherRAILROAD MEDICARE (RRM)
CARN5104400Medicaid
P00148619OtherRAILROAD MEDICARE (RRM)
CAP28354Medicare UPIN
CAZZZ9973ZMedicare ID - Type Unspecified