Jaxon Dean Anderson, CRNA
Nurse Anesthetist, Certified Registered in Idaho Falls, ID. Individual provider (NPI-1).
NPI number1043568892
StatusActive
Last updated in NPPESJul 21, 2022
Details
- NPI
- 1043568892
- Entity type
- Individual (NPI-1)
- Name
- Jaxon Dean Anderson
- Credential
- CRNA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 28, 2012
- Last updated
- Jul 21, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 847A | ID | Yes |
| 163W00000X | Registered Nurse | N-36657 | ID |
Practice location
2325 Coronado StIdaho Falls, ID 83404-7407
Phone 208-557-2700
Mailing address
Po Box 4268Portland, OR 97208-4268
Phone 503-372-2740 · Fax 503-372-2754
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