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General NPI Number Information
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NPI Number | 1609113927
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Entity Type | Individual
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Provider Name | JARED A BEVAN CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/07/2013
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 1055 N. CURTIS RD.
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City | BOISE
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State | ID
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Zip | 83706-8370
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Country | US
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Telephone | 503-372-2763
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4268
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City | PORTLAND
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State | OR
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Zip | 97208-9720
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Country | US
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Telephone | 503-372-2740
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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 | RN 9306861
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License Number State | FL
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