Individual
JACOB DANIEL MILLWOOD
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) 984-1000
Mailing address
208 MEMORY LN, MADISON, MS 39110-6890
(662) 836-8621
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
901474
MS
Other
Enumeration date
12/28/2017
Last updated
12/28/2017
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