Individual
ZACHARY MICHAEL JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
900 SUNSET DR, LA GRANDE, OR 97850-1387
(541) 963-8421
Mailing address
1719 IRA WAY, SYRACUSE, UT 84075-9492
(801) 425-0528
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
10019614
OR
Other
Enumeration date
01/02/2024
Last updated
01/02/2024
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