Healthcare Provider Details

I. General information

NPI: 1427443159
Provider Name (Legal Business Name): JESSICA THURLOW CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11154 COUNTY ROAD 19
BLAIR NE
68008-3626
US

IV. Provider business mailing address

11154 COUNTY ROAD 19
BLAIR NE
68008-3626
US

V. Phone/Fax

Practice location:
  • Phone: 402-719-7325
  • Fax:
Mailing address:
  • Phone: 402-719-7325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number105293
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: