1376536557 NPI number — MRS. JENNIFER HONSAKER CRNA

Table of content: MRS. JENNIFER HONSAKER CRNA (NPI 1376536557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376536557 NPI number — MRS. JENNIFER HONSAKER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HONSAKER
Provider First Name:
JENNIFER
Provider Middle Name:
Provider Name Prefix Text:
MRS.
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376536557
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
139 GREENTREE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44202-7906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-844-3777
Provider Business Mailing Address Fax Number:
216-844-3780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29017 CEDAR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNDHURST
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44124-4073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-460-8000
Provider Business Practice Location Address Fax Number:
440-460-1759
Provider Enumeration Date:
08/24/2005

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:  46695 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 46695 , 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)

  • Identifier: 000000221249 . This is a "UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 414981 . This is a "WELLCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 750644 . This is a "BUCKEYE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7859973 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000515992 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00678108 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0187677 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0583328 . This is a "BCMH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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