Individual
MR. JEFFREY DUANE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
500 S MAPLE ST, WACONIA, MN 55387-1752
(952) 442-2191
Mailing address
4510 ENCHANTED DR, MOUND, MN 55364-9300
(952) 474-5937
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R113772-3
MN
Other
Enumeration date
11/30/2006
Last updated
07/08/2007
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