| NPI | 1205301587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN G JACKSON CFO 870-541-7370 |
| Organization Subpart ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered |
| Additional Taxonomies | 207L00000X Anesthesiology |
| Enumeration Date | 2018-10-12 |
| Last Update Date | 2018-10-12 |