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General NPI Number Information
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NPI Number | 1851361091
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Entity Type | Individual
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Provider Name | JEFFREY M DAXE CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4102 PINION DR 10 MDOS/SGOSA
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City | U S A F ACADEMY
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State | CO
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Zip | 80840-2502
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Country | US
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Telephone | 719-333-5691
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Fax |
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Provider Business Mailing Address
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Address Line | 679 BURKE HOLLOW DR.
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City | MONUMENT
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State | CO
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Zip | 80132
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Country | US
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Telephone | 719-481-3159
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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-277423/NA-07861
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License Number State | OH
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