Healthcare Provider Details

I. General information

NPI: 1871092767
Provider Name (Legal Business Name): JESSICA SALLEE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA EVERS CRNA

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BELLEFONTAINE AVE
LIMA OH
45804-2800
US

IV. Provider business mailing address

1001 BELLEFONTAINE AVE
LIMA OH
45804-2800
US

V. Phone/Fax

Practice location:
  • Phone: 419-228-3335
  • Fax:
Mailing address:
  • Phone: 419-226-5018
  • Fax: 419-998-4514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019639
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: