| Jacob David Sandefur, CRNA | |
|
900 Sunset Dr, La Grande, OR 97850-1387 | |
| (541) 963-8421 | |
| Not Available |
| Full Name | Jacob David Sandefur |
|---|---|
| Gender | Male |
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 900 Sunset Dr, La Grande, Oregon |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770212417 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 163W00000X | Registered Nurse | 239503 (Tennessee) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | 202214569CRNAPP (Oregon) | Primary |
| Entity Name | Grande Ronde Hospital Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1467446195 PECOS PAC ID: 0547170789 Enrollment ID: O20031124000758 |
| Mailing Address | Practice Location Address |
|---|---|
| Jacob David Sandefur, CRNA 2302 E N Ct, La Grande, OR 97850-3858 Ph: (541) 519-0890 | Jacob David Sandefur, CRNA 900 Sunset Dr, La Grande, OR 97850-1387 Ph: (541) 963-8421 |
Zachary Michael Jacobsen, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 900 Sunset Dr, La Grande, OR 97850 Phone: 541-963-8421 | |
Bradley Robert Close, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 900 Sunset Dr, La Grande, OR 97850 Phone: 541-963-8421 Fax: 541-963-1476 | |
Sheridan D Klinger, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 900 Sunset Dr, La Grande, OR 97850 Phone: 541-963-1401 Fax: 541-963-1502 |