Healthcare Provider Details

I. General information

NPI: 1912328352
Provider Name (Legal Business Name): JENNIFER CAMPBELL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER GABLE

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTHERN BLVD
KETTERING OH
45429-1221
US

IV. Provider business mailing address

PO BOX 932759
CLEVELAND OH
44193-0015
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-8228
  • Fax: 937-293-8229
Mailing address:
  • Phone: 937-293-8228
  • Fax: 937-293-8229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN313950
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.15482-NA
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.15482
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: