Individual
JASON G GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
100 HOSPITAL DR, LEBANON, MO 65536-9210
(417) 533-6100
(417) 533-6021
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2005008115
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790091635
—
MO
Enumeration date
08/30/2010
Last updated
08/23/2022
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