Healthcare Provider Details

I. General information

NPI: 1144250424
Provider Name (Legal Business Name): JASPER MICHAEL NEUSE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WALTER REED BLVD STE.302
GARLAND TX
75042-3701
US

IV. Provider business mailing address

7303 ROBIN RD
DALLAS TX
75209-3921
US

V. Phone/Fax

Practice location:
  • Phone: 972-276-6100
  • Fax:
Mailing address:
  • Phone: 817-988-8845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number239486
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: