Individual
JORDAN LILJENQUIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4800 E JOHNSON AVE, JONESBORO, AR 72405-8413
(208) 312-2542
Mailing address
2720 GREENSBORO RD, JONESBORO, AR 72405-8398
(208) 312-2542
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
136634
AR
Other
Enumeration date
04/30/2021
Last updated
04/11/2022
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