Individual
JACOB EDLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
5225 23RD AVE S, FARGO, ND 58104-7927
(701) 417-2000
Mailing address
PO BOX 2168, FARGO, ND 58107-2168
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
PENDING
ND
Other
Enumeration date
09/19/2019
Last updated
09/19/2019
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