Individual
NOAH CURRENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3801 S NATIONAL AVE, SPRINGFIELD, MO 65807-5210
(417) 269-6000
Mailing address
1000 E PRIMROSE ST STE 520, SPRINGFIELD, MO 65807-5180
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2010005574
MO
Other
Enumeration date
03/16/2010
Last updated
03/16/2010
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