Jeremiah Jack, CRNA
Nurse Anesthetist, Certified Registered in Vallejo, CA. Individual provider (NPI-1).
NPI number1972995280
StatusActive
Last updated in NPPESDec 30, 2021
Details
- NPI
- 1972995280
- Entity type
- Individual (NPI-1)
- Name
- Jeremiah Jack
- Credential
- CRNA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 24, 2015
- Last updated
- Dec 30, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 95000285 | CA | Yes |
Practice location
975 Sereno DrVallejo, CA 94589-2441
Phone 707-651-3884
Mailing address
975 Sereno DrVallejo, CA 94589-2441
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