JACKIE FORTENBERRY

JACKSON, MS
NPI1609902337
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy367500000X Nurse Anesthetist, Certified Registered
(Licence: MS  R114980)
Enumeration Date2007-02-26
Last Update Date2007-07-08
Business Address
-- JACKIE FORTENBERRY CRNA
1225 N STATE ST
JACKSON, MS 39202-2064
Phone number: 601-968-1362
Mailing Address
-- JACKIE FORTENBERRY CRNA
PO BOX 23090
JACKSON, MS 39225-3090
Phone number: 601-968-1362
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