Healthcare Provider Details

I. General information

NPI: 1871598821
Provider Name (Legal Business Name): JEANNETTE BARNES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 POPLAR CHURCH RD
CAMP HILL PA
17011-2206
US

IV. Provider business mailing address

899 POPLAR CHURCH RD
CAMP HILL PA
17011-2206
US

V. Phone/Fax

Practice location:
  • Phone: 717-763-0430
  • Fax: 717-763-9854
Mailing address:
  • Phone: 717-763-0430
  • Fax: 717-763-9854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License NumberRN126243L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: