Individual
CASEY JORDAN ELISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2823 FRESNO ST, FRESNO, CA 93721
(559) 459-6000
(559) 498-8182
Mailing address
PO BOX 7096, STOCKTON, CA 95267-0096
(209) 956-7725
(209) 956-7733
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
NA95001060
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41321
BOARD OF REGISTERED NURSING
ID
01
—
95109684
BOARD OF REGISTERED NURSING
CA
01
—
NA950001060
BOARD OF REGISTERED NURSING
CA
Enumeration date
01/09/2019
Last updated
05/20/2019
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