1952644841 NPI number — MISS JENNIFER SUE GIOIA CRNA

Table of content: MISS JENNIFER SUE GIOIA CRNA (NPI 1952644841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952644841 NPI number — MISS JENNIFER SUE GIOIA CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIOIA
Provider First Name:
JENNIFER
Provider Middle Name:
SUE
Provider Name Prefix Text:
MISS
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:
JERDEE
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952644841
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16610 54TH AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55446-3837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-490-8476
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16610 54TH AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55446-3837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-490-8476
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2013

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: 163W00000X , with the licence number:  R 208422-8 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 2201 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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