Individual
JACOB MADEIRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(215) 316-5151
Mailing address
51 N 39TH ST, PHILADELPHIA, PA 19104-2640
(215) 662-8244
(215) 274-3560
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN628956
PA
Other
Enumeration date
04/18/2022
Last updated
05/24/2024
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