Individual
JARROD P FONTENELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
215 MARION AVE, MCCOMB, MS 39648-2705
(334) 279-1450
(334) 279-1660
Mailing address
PO BOX 235019, MONTGOMERY, AL 36123-5019
(334) 279-1450
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R863487
MS
Other
Enumeration date
07/18/2018
Last updated
07/18/2018
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