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General NPI Number Information
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NPI Number | 1922439264
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Entity Type | Individual
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Provider Name | JASON M LARSEN CRNA, DNP
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Gender | Male
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Dates
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Enumeration Date | 12/12/2013
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 800 ROSE ST
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City | LEXINGTON
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State | KY
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Zip | 40536-8237
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Country | US
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Telephone | 859-323-5956
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Fax | 859-323-1080
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Provider Business Mailing Address
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Address Line | 1009 NOVUS DR STE 2
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City | JOHNSON CITY
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State | TN
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Zip | 37604-8237
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Country | US
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Telephone | 423-283-0776
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Fax | 423-283-0549
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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 | APN19921
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License Number State | TN
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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 | 4018931
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License Number State | KY
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