Healthcare Provider Details

I. General information

NPI: 1972889848
Provider Name (Legal Business Name): JASON ALLEN RAMAKER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S MAIN ST
CROWN POINT IN
46307-8481
US

IV. Provider business mailing address

9457 MONROE ST APT. 1005
CROWN POINT IN
46307-6245
US

V. Phone/Fax

Practice location:
  • Phone: 219-757-6389
  • Fax:
Mailing address:
  • Phone: 616-634-3877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number88656
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: