Provider Demographics
NPI:1093846487
Name:WHITEFOOT, JASON T (CRNA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:T
Last Name:WHITEFOOT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4159 SOPHIAS WAY
Mailing Address - Street 2:
Mailing Address - City:CLEVES
Mailing Address - State:OH
Mailing Address - Zip Code:45002-1410
Mailing Address - Country:US
Mailing Address - Phone:513-205-3922
Mailing Address - Fax:
Practice Address - Street 1:4159 SOPHIAS WAY
Practice Address - Street 2:
Practice Address - City:CLEVES
Practice Address - State:OH
Practice Address - Zip Code:45002-1410
Practice Address - Country:US
Practice Address - Phone:513-205-3922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN303213367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2758305Medicaid