Provider Demographics
NPI:1770521437
Name:HEYREND, JAMES LEE (CRNA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LEE
Last Name:HEYREND
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 1:702 N DORIAN DR
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-1827
Mailing Address - Country:US
Mailing Address - Phone:208-740-4134
Mailing Address - Fax:541-889-6114
Practice Address - Street 1:702 N DORIAN DR
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-1827
Practice Address - Country:US
Practice Address - Phone:208-740-4134
Practice Address - Fax:541-889-6114
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ220083367500000X
NC51143367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8052389Medicaid
AZ585068Medicaid