Healthcare Provider Details

I. General information

NPI: 1932565389
Provider Name (Legal Business Name): JENNIFER ELLENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 W PITTSBURGH ST
GREENSBURG PA
15601-2239
US

IV. Provider business mailing address

PO BOX 431
LANDISVILLE PA
17538-0431
US

V. Phone/Fax

Practice location:
  • Phone: 724-832-4000
  • Fax:
Mailing address:
  • Phone: 800-339-5844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN564707
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: