Individual
JACOB BRADLEY STAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN, CRNA
Contact information
Practice address
1300 ANNE ST NW, BEMIDJI, MN 56601-5103
(218) 333-5000
Mailing address
400 E 3RD ST, DULUTH, MN 55805-1951
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
347
MN
367500000X
Certified Registered Nurse Anesthetist
R190783-0
MN
Other
Enumeration date
12/25/2011
Last updated
03/14/2023
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