1871744698 NPI number — JENNIFER CATHERINE MOELLER CRNA

Table of content: JENNIFER CATHERINE MOELLER CRNA (NPI 1871744698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871744698 NPI number — JENNIFER CATHERINE MOELLER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOELLER
Provider First Name:
JENNIFER
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILHELM
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
CATHERINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871744698
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 BURNET AVE.
Provider Second Line Business Mailing Address:
ANESTHESIA, ML 2001
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45229-3039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-636-4408
Provider Business Mailing Address Fax Number:
513-636-7337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 BURNET AVE.
Provider Second Line Business Practice Location Address:
ANESTHESIA, ML 2001
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45229-3039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-636-4408
Provider Business Practice Location Address Fax Number:
513-636-7337
Provider Enumeration Date:
10/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN.299752 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com