Provider Demographics
NPI:1881660272
Name:SANDERS, JASON DAVID (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:DAVID
Last Name:SANDERS
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 1:4855 AIRLINE DR
Mailing Address - Street 2:APT 10B
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-6600
Mailing Address - Country:US
Mailing Address - Phone:318-549-0378
Mailing Address - Fax:
Practice Address - Street 1:4855 AIRLINE DR
Practice Address - Street 2:APT 10B
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-6600
Practice Address - Country:US
Practice Address - Phone:318-549-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA095633367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1174971Medicaid
LA4C572C734Medicare PIN