Provider Demographics
NPI:1437398229
Name:CARLISLE, JEREMY (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:CARLISLE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:JEREMY
Other - Middle Name:
Other - Last Name:CARLISLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:216 14TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-3519
Mailing Address - Country:US
Mailing Address - Phone:406-488-2100
Mailing Address - Fax:
Practice Address - Street 1:216 14TH AVE SW
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-3519
Practice Address - Country:US
Practice Address - Phone:406-488-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT37444367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered