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General NPI Number Information
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NPI Number | 1386283067
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Entity Type | Individual
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Provider Name | JOSHUA RAJALA CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/30/2019
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Last Update Date | 12/30/2019
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Provider Practice Location Address
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Address Line | 850 W BARAGA AVE
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City | MARQUETTE
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State | MI
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Zip | 49855-4550
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Country | US
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Telephone | 906-449-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 171 LAKEWOOD LN
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City | MARQUETTE
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State | MI
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Zip | 49855-9543
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Country | US
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Telephone | 262-894-0123
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4704311804
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License Number State | MI
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