Healthcare Provider Details

I. General information

NPI: 1477520542
Provider Name (Legal Business Name): JASON D KLEIN CRNA, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 CARLSON ST
MARSHALL MN
56258-2626
US

IV. Provider business mailing address

1407 RIDGEWAY RD
MARSHALL MN
56258-2153
US

V. Phone/Fax

Practice location:
  • Phone: 507-532-1901
  • Fax:
Mailing address:
  • Phone: 507-829-9487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR1402746
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR027248
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: