Individual
JERRY R TOWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
900 E BROADWAY AVENUE, BISMARCK, NC 58501
(701) 530-7000
(701) 530-8842
Mailing address
900 E BROADWAY AVENUE, P.O. BOX 5510, BISMARCK, NC 58506-5510
(701) 530-7000
(701) 530-8842
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R20847
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12484
—
ND
Enumeration date
01/19/2007
Last updated
07/08/2007
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