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Individual

JONATHAN M LOETSCHER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
1801 W 40TH AVE, SUITE 2B, PINE BLUFF, AR 71603-6940
(870) 535-7457
(870) 535-2522
Mailing address
1801 W 40TH AVE, SUITE 2B, PINE BLUFF, AR 71603-6940
(870) 535-7457
(870) 535-2522

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C02665
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
165921001
AR
01
432710240
PGBA TRICARE
01
5A486
BCBS
AR
01
P00428045
RR MCR
Enumeration date
07/12/2007
Last updated
06/24/2008
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