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General NPI Number Information
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NPI Number | 1144250424
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Entity Type | Individual
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Provider Name | JASPER MICHAEL NEUSE CRNA
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 700 WALTER REED BLVD STE.302
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City | GARLAND
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State | TX
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Zip | 75042-3701
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Country | US
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Telephone | 972-276-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 7303 ROBIN RD
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City | DALLAS
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State | TX
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Zip | 75209-3921
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Country | US
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Telephone | 817-988-8845
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 239486
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License Number State | TX
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