Individual
JACOB DAVID SANDEFUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
900 SUNSET DR, LA GRANDE, OR 97850-1387
(541) 963-8421
Mailing address
2302 E N CT, LA GRANDE, OR 97850-3858
(541) 519-0890
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
239503
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
202214569CRNAPP
OR
Other
Enumeration date
06/08/2022
Last updated
09/23/2022
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