Healthcare Provider Details

I. General information

NPI: 1609354000
Provider Name (Legal Business Name): JENNIFER MARGARET BISSEY CRNA, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MARGARET WOELFEL

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3643 N ROXBORO ST
DURHAM NC
27704-2702
US

IV. Provider business mailing address

1419 WOODLAND DR
DURHAM NC
27701-1251
US

V. Phone/Fax

Practice location:
  • Phone: 919-370-6169
  • Fax:
Mailing address:
  • Phone: 919-260-6036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number251099
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: