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NPI Code Detail

MEDICARE: JASON BROOKS CRNA

MEDICARE: JASON BROOKS CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist132099MO

General Provider Information

NPI Number : 1205811924
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON BROOKS CRNA
Provider Business Mailing Address
First Line : 1500 N OAKLAND AVE
Second Line :
City : BOLIVAR
State : MO
Zip : 65613-3011
Country : US
Telephone Number : 417-777-6911
Fax Number : 660-826-4852
Provider Business Practice Location Address
First Line : 1500 N OAKLAND AVE
Second Line :
City : BOLIVAR
State : MO
Zip : 65613-3011
Country : US
Telephone Number : 417-777-6911
Fax Number : 660-826-4852
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2005
Last Update Date : 07/08/2007

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