Provider Demographics
NPI:1801892641
Name:JAMES, FREDERICK (CRNA)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:JAMES
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 1:118 SAND LAPPER CV
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-9316
Mailing Address - Country:US
Mailing Address - Phone:516-241-7736
Mailing Address - Fax:516-499-9005
Practice Address - Street 1:259 1ST ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3957
Practice Address - Country:US
Practice Address - Phone:516-741-0570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY395603367500000X
GA257003367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0422BNMedicare ID - Type UnspecifiedGHI MEDICARE
NYR2C981Medicare ID - Type UnspecifiedEMPIRE MEDICARE