Individual
MRS. AMANDA NICOLE LOVELADY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1207 7TH STREET SE, DECATUR, AL 35601
(256) 341-2000
Mailing address
1402 20TH AVE SE, DECATUR, AL 35601-5216
(256) 654-1996
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
75119
AL
Other
Enumeration date
10/02/2006
Last updated
07/08/2007
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