Healthcare Provider Details

I. General information

NPI: 1215346002
Provider Name (Legal Business Name): JESSICA A SIEGFERTH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA CROOKS CRNA

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29000 CENTER RIDGE RD
WESTLAKE OH
44145
US

IV. Provider business mailing address

PO BOX 78000 DEPT 781589
DETROIT MI
48278-1589
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-6440
  • Fax: 517-787-4146
Mailing address:
  • Phone: 517-787-6440
  • Fax: 517-787-4146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.16592
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: