Individual
MARK D LASSWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1600 N 2ND ST, CLINTON, MO 64735-1297
(660) 885-5511
Mailing address
1600 N 2ND ST, CLINTON, MO 64735-1297
(660) 885-5511
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
115280
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100786980A
—
OK
05
—
158890001
—
AR
01
—
17703
COX HEALTH
MO
01
—
19411
BCBS
MO
01
—
20174319965615A002
TRICARE
MO
01
—
741190
HEALTHLINK
MO
05
—
916892334
—
MO
01
—
P00213245
RAILROAD
MO
Enumeration date
09/14/2005
Last updated
03/30/2022
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