MEDICARE: JACOB WILLIAM PRESSLER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	209009628	IL

General Provider Information

NPI Number	:	1467711226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB WILLIAM PRESSLER CRNA

Provider Business Mailing Address
First Line	:	725 TUXEDO BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-1946
Country	:	US
Telephone Number	:	314-471-4661
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 TUXEDO BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-1946
Country	:	US
Telephone Number	:	314-471-4661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2012
Last Update Date	:	01/29/2015

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