Healthcare Provider Details

I. General information

NPI: 1386279081
Provider Name (Legal Business Name): JARED DEAN WORKMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4021 AVENUE B
SCOTTSBLUFF NE
69361-4602
US

IV. Provider business mailing address

2610 ADDISON AVE
SCOTTSBLUFF NE
69361-1800
US

V. Phone/Fax

Practice location:
  • Phone: 308-635-3711
  • Fax:
Mailing address:
  • Phone: 208-339-3423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101557
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: