Provider Demographics
NPI:1477520542
Name:KLEIN, JASON D (CRNA, MS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:KLEIN
Suffix:
Gender:M
Credentials:CRNA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 RIDGEWAY RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-2153
Mailing Address - Country:US
Mailing Address - Phone:507-829-9487
Mailing Address - Fax:
Practice Address - Street 1:1521 CARLSON ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2626
Practice Address - Country:US
Practice Address - Phone:507-532-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1402746367500000X
SDR027248367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered