Individual
JACOB ALLEN RODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1200 J D ANDERSON DR, MORGANTOWN, WV 26505-3494
(706) 650-0705
Mailing address
118 CHESS RD, SMITHFIELD, PA 15478-1418
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
72425
WV
Other
Enumeration date
01/07/2013
Last updated
11/15/2018
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