Provider Demographics
NPI:1144250424
Name:NEUSE, JASPER MICHAEL (CRNA)
Entity type:Individual
Prefix:
First Name:JASPER
Middle Name:MICHAEL
Last Name:NEUSE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7303 ROBIN RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-3921
Mailing Address - Country:US
Mailing Address - Phone:817-988-8845
Mailing Address - Fax:
Practice Address - Street 1:700 WALTER REED BLVD
Practice Address - Street 2:STE.302
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-3701
Practice Address - Country:US
Practice Address - Phone:972-276-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239486367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144394705Medicaid
TX144394703Medicaid
TX87651UOtherBCBS
TX8L9574OtherTX MEDICARE
TX8J4968Medicare PIN
TX8L9574OtherTX MEDICARE
TX8F1962Medicare PIN