Individual
JACQUELYN GUMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
5151 REED RD, SUITE 225-C, COLUMBUS, OH 43220-2595
(614) 975-4796
(614) 884-0776
Mailing address
5151 REED RD, SUITE 225-C, COLUMBUS, OH 43220-2595
(614) 975-4796
(614) 884-0776
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
COA.15833-NA
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0104362
—
OH
01
—
COA.15833-NA
STATE COA LICENSE
OH
01
—
P01381010
RAILROAD MEDICARE
OH
Enumeration date
02/04/2013
Last updated
05/20/2015
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