Individual
JENNIFER K JUSTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1-087156
AL
367500000X
Certified Registered Nurse Anesthetist
Primary
1-087156
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102382 1801867338
—
AL
01
—
344343
WELLCARE CMO - MCCG
GA
01
—
430080316
RAILROAD MCR - MCCG
GA
01
—
51591711
BCBS
AL
01
—
671345126A
PEACHSTATE CMO - MCCG
GA
05
—
671345126A
—
GA
05
—
671345126B
—
AL
Enumeration date
05/01/2007
Last updated
05/07/2018
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