Individual
JACLYN M JOHANBOEKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
10207 SPRINGHURST GARDENS CIR, LOUISVILLE, KY 40241-5194
(502) 548-3117
Mailing address
10207 SPRINGHURST GARDENS CIR, LOUISVILLE, KY 40241-5194
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1107361
KY
Other
Enumeration date
10/18/2010
Last updated
03/31/2012
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