Individual
MR. JAMES TIMOTHY STACKHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
US HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-6401
(505) 368-6431
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6401
(505) 368-6431
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
03435481
NY
367500000X
Certified Registered Nurse Anesthetist
CRNA00781
NM
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA0631
AZ
367500000X
Certified Registered Nurse Anesthetist
R49230NM
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
697766
—
AZ
05
—
79836534
—
CO
05
—
R5071
—
NM
Enumeration date
10/07/2005
Last updated
01/25/2011
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