Provider Demographics
NPI:1982671285
Name:JAMESON, SCOTT RODNEY (CRNA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:RODNEY
Last Name:JAMESON
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 1:1222 E WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BARRON
Mailing Address - State:WI
Mailing Address - Zip Code:54812-1765
Mailing Address - Country:US
Mailing Address - Phone:715-537-3166
Mailing Address - Fax:
Practice Address - Street 1:1222 E WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:BARRON
Practice Address - State:WI
Practice Address - Zip Code:54812-1765
Practice Address - Country:US
Practice Address - Phone:715-537-3166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-089447-8367500000X
WI101267367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN524543500Medicaid
MN524543500Medicaid