Healthcare Provider Details

I. General information

NPI: 1104216415
Provider Name (Legal Business Name): JASON FIFE RN, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 MILL STONE RD
CHESAPEAKE VA
23322-4339
US

IV. Provider business mailing address

214 VINE ST
MUNHALL PA
15120-2215
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-8121
  • Fax:
Mailing address:
  • Phone: 352-672-7758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024172277
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: