Provider Demographics
NPI:1538272372
Name:STIMPSON, JAMES (CRNA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:STIMPSON
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 1:3765 S 3650 W
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-9373
Mailing Address - Country:US
Mailing Address - Phone:801-731-0173
Mailing Address - Fax:
Practice Address - Street 1:3765 S 3650 W
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:UT
Practice Address - Zip Code:84401-9373
Practice Address - Country:US
Practice Address - Phone:801-791-9566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4758542-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT49108OtherHEALTHY U
UT190246100OtherDEPT OF LABOR
UT68295OtherPEHP
UT218518OtherALTIUS
UT005780206Medicare ID - Type Unspecified
UTP00142903Medicare ID - Type UnspecifiedRAILROAD MEDICARE
UT68295OtherPEHP