Individual
MADISON N SISTRUNK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
897105
MS
367500000X
Certified Registered Nurse Anesthetist
Primary
NOWE-43CHVU
MS
Other
Enumeration date
12/20/2018
Last updated
06/29/2021
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