Healthcare Provider Details

I. General information

NPI: 1750344529
Provider Name (Legal Business Name): JENNIFER CORETTA HARVEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 PROSPECT AVE BASEMENT SUITE
BROOKLYN NY
11215-6065
US

IV. Provider business mailing address

306 GOLD ST #32A
BROOKLYN NY
11201-3051
US

V. Phone/Fax

Practice location:
  • Phone: 718-369-1444
  • Fax: 718-369-3066
Mailing address:
  • Phone: 732-899-0868
  • Fax: 732-899-5167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number454924-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: