Healthcare Provider Details

I. General information

NPI: 1982650305
Provider Name (Legal Business Name): JENNIFER L CRONENWETT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 E 32ND ST STE 6
JOPLIN MO
64804-9810
US

IV. Provider business mailing address

5404 BUTTERFIELD PL
LOMA LINDA MO
64804-8870
US

V. Phone/Fax

Practice location:
  • Phone: 417-627-9699
  • Fax: 417-627-9602
Mailing address:
  • Phone: 417-439-7448
  • Fax: 417-782-7831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2004000338
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: