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NPI Code Detail

MEDICARE: JASON WITZEL CRNA

MEDICARE: JASON WITZEL CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist43-557387-122KS

General Provider Information

NPI Number : 1164889317
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON WITZEL CRNA
Provider Business Mailing Address
First Line : 107 CORRAL WAY APT A
Second Line :
City : DODGE CITY
State : KS
Zip : 67801-7253
Country : US
Telephone Number : 205-585-1301
Fax Number :
Provider Business Practice Location Address
First Line : 107 CORRAL WAY APT A
Second Line :
City : DODGE CITY
State : KS
Zip : 67801-7253
Country : US
Telephone Number : 205-585-1301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2016
Last Update Date : 01/19/2016

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Directions to “ JASON WITZEL CRNA” Practice Location

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