Provider Demographics
NPI:1104814300
Name:NAYIGIZIKI, JEROME (CRNA)
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:
Last Name:NAYIGIZIKI
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GREAT SALT LK
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-1947
Mailing Address - Country:US
Mailing Address - Phone:956-723-9975
Mailing Address - Fax:
Practice Address - Street 1:1710 E SAUNDERS ST
Practice Address - Street 2:SUITE 384
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5443
Practice Address - Country:US
Practice Address - Phone:956-523-8875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX691935367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered