Provider Demographics
NPI:1851361091
Name:DAXE, JEFFREY M (CRNA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:DAXE
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 1:679 BURKE HOLLOW DR.
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132
Mailing Address - Country:US
Mailing Address - Phone:719-481-3159
Mailing Address - Fax:
Practice Address - Street 1:4102 PINION DR
Practice Address - Street 2:10 MDOS/SGOSA
Practice Address - City:U S A F ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-2502
Practice Address - Country:US
Practice Address - Phone:719-333-5691
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-277423/NA-07861367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered