Individual
JASON L MORTENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
7 INDEPENDENCE PT STE 300, GREENVILLE, SC 29615-4569
(864) 522-3700
(864) 522-3705
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4207
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30074985
SELECT HEALTH
SC
05
—
602239655B
—
GA
05
—
AN2060
—
SC
01
—
NPI #
BLUE CHOICE
SC
01
—
NPI #/ SSN#
BLUE CROSS OF SC
SC
Enumeration date
05/31/2010
Last updated
01/27/2022
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