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General NPI Number Information
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NPI Number | 1215174669
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Entity Type | Individual
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Provider Name | JESSE JARNES CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/07/2009
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Last Update Date | 01/07/2009
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Provider Practice Location Address
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Address Line | 3225 POCAHONTAS RD ST. ELIZABETH HEALTH SERVICES
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City | BAKER CITY
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State | OR
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Zip | 97814
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Country | US
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Telephone | 541-523-8813
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Fax | 541-523-1709
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Provider Business Mailing Address
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Address Line | PO BOX 804
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City | BAKER CITY
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State | OR
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Zip | 97814-0804
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Country | US
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Telephone | 208-661-9880
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Fax | 541-523-1709
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 200340013RN
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 200860055CRNA
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License Number State | OR
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