Individual
MARK J SISTRUNK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
971 LAKELAND DR, SUITE 202, JACKSON, MS 39216-4643
(601) 362-1990
(601) 362-1988
Mailing address
971 LAKELAND DR, SUITE 202, JACKSON, MS 39216-4643
(601) 362-1990
(601) 362-1988
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R857282
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R857282
RN LICENSE
MS
Enumeration date
01/09/2008
Last updated
01/09/2008
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