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General NPI Number Information
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NPI Number | 1760117626
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Entity Type | Individual
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Provider Name | JACOB ROWLEY CRNA
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Gender | Male
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Dates
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Enumeration Date | 07/22/2022
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 44405 WOODWARD AVE
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City | PONTIAC
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State | MI
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Zip | 48341-5023
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Country | US
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Telephone | 248-858-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 13945 EDERER RD
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City | HEMLOCK
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State | MI
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Zip | 48626-7400
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Country | US
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Telephone | 989-928-0925
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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 | 4704341360
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License Number State | MI
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