Individual
CASEY JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
746 JEFFERSON AVE, SCRANTON, PA 18510-1624
(570) 348-7100
Mailing address
3998 FAIR RIDGE DR, STE 300, FAIRFAX, VA 22033-2907
(703) 295-9360
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN636253
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2452895
—
OH
Enumeration date
05/17/2006
Last updated
03/20/2015
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