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NPI Code Detail

MEDICARE: LEONARD JAZZEL BONUS JR. CRNA

MEDICARE: LEONARD JAZZEL BONUS JR. 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 Anesthetist10050197OR
2367500000XCertified Registered Nurse Anesthetist1137544TX

General Provider Information

NPI Number : 1720869126
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEONARD JAZZEL BONUS JR. CRNA
Provider Business Mailing Address
First Line : 500 NE MULTNOMAH ST STE 100
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2031
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10180 SE SUNNYSIDE RD
Second Line :
City : CLACKAMAS
State : OR
Zip : 97015-8970
Country : US
Telephone Number : 800-813-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2023
Last Update Date : 01/16/2026

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