Provider Demographics
NPI:1316482953
Name:ONDER, JARED (CRNA)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:ONDER
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 1:613 NW 1ST AVE UNIT 112A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2765
Mailing Address - Country:US
Mailing Address - Phone:218-910-8078
Mailing Address - Fax:
Practice Address - Street 1:613 NW 1ST AVE UNIT 112A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2765
Practice Address - Country:US
Practice Address - Phone:218-910-8078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN242414-7367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered