Individual
NANCY T JETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
677 CHURCH ST NE, MARIETTA, GA 30060-1101
(770) 794-0477
(770) 794-3108
Mailing address
PO BOX 932840, ATLANTA, GA 31193-2925
(800) 749-2940
(706) 660-1454
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN091310
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000856963E
—
GA
01
—
1235184185
NPI
GA
01
—
1982637419
GROUP NPI
GA
Enumeration date
05/22/2006
Last updated
08/27/2019
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