Basic Information
| Provider Information | |||||||||
| NPI: | 1104216415 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FIFE | ||||||||
| FirstName: | JASON | ||||||||
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| Credential: | RN, CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 VINE ST | ||||||||
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| City: | MUNHALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151202215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526727758 | ||||||||
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| Practice Location | |||||||||
| Address1: | 429 MILL STONE RD | ||||||||
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| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233224339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573128121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2015 | ||||||||
| LastUpdateDate: | 01/26/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 0024172277 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.