Individual
THOMAS ANDREW JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1995 EAST STATE STREET, SALEM REGIONAL MEDICAL CENTER, SALEM, OH 44460
(330) 332-1551
(330) 332-7899
Mailing address
2507 N MERCER ST, NEW CASTLE, PA 16105-1707
(724) 944-1972
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN.396530-1
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
COA.18640-NA
OH
Other
Enumeration date
02/16/2016
Last updated
11/11/2023
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