Individual
MRS. JODIE BROCK MAUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2520 5TH ST N, COLUMBUS, MS 39705-2008
(662) 244-1000
Mailing address
114 NORTHGATE DR, STARKVILLE, MS 39759-9742
(662) 694-1105
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R874196
MS
Other
Enumeration date
09/20/2010
Last updated
09/20/2010
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