Individual
TONY LEE SISTRUNK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-2005
Mailing address
504 CLINTON CENTER DRIVE, CBO SUITE 4300, CLINTON, MS 39056
(601) 815-2005
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
901891
MS
Other
Enumeration date
01/26/2024
Last updated
01/26/2024
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