Individual
JON LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
800 W 9TH ST, JASPER, IN 47546-2514
(812) 996-2345
(812) 996-2345
Mailing address
800 W 9TH ST, JASPER, IN 47546-2514
(812) 996-0643
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
99001630
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000185017
ANTHEM BS
IN
01
—
99001630
INDIANA LICENSE
IN
Enumeration date
12/21/2006
Last updated
08/14/2013
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