Healthcare Provider Details

I. General information

NPI: 1841754983
Provider Name (Legal Business Name): JACOB SZAJKOWSKI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30258 EKLUND AVE
EAGLE RIVER AK
99577-9707
US

IV. Provider business mailing address

30258 EKLUND AVE
EAGLE RIVER AK
99577-9707
US

V. Phone/Fax

Practice location:
  • Phone: 970-692-7911
  • Fax:
Mailing address:
  • Phone: 970-692-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number150214
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: