Individual
JEREMY SHANE BISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2430 W PIERCE ST, CARLSBAD, NM 88220-3553
(318) 934-2242
Mailing address
PO BOX 1547, SEDALIA, MO 65302-1547
(660) 826-5960
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA-01281
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78584051
—
NM
Enumeration date
11/01/2012
Last updated
07/01/2016
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