Basic Information
| Provider Information | |||||||||
| NPI: | 1871567677 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1803 MOUNT ROSE AVE | ||||||||
| Address2: | SUITE B3 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178516969 | ||||||||
| Practice Location | |||||||||
| Address1: | 147 GETTYS ST | ||||||||
| Address2: | |||||||||
| City: | GETTYSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173252534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173374168 | ||||||||
| FaxNumber: | 7173374318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 07/30/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 003202 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | RN529448L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 9513226 | 01 | PA | AETNA | OTHER | 2065504 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 119991 | 01 | PA | GEISINGER HELATH PLAN | OTHER | 20078677 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 259913 | 01 | PA | UNISON-WMG | OTHER | 1573889 | 01 | PA | GATEWAY-WMG | OTHER | 50080769 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER |