Healthcare Provider Details

I. General information

NPI: 1174524961
Provider Name (Legal Business Name): JENNIFER M MICHELANGELO CRNA, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 S BEESON AVE
UNIONTOWN PA
15401-4249
US

IV. Provider business mailing address

192 S BEESON AVE
UNIONTOWN PA
15401-4249
US

V. Phone/Fax

Practice location:
  • Phone: 412-582-5869
  • Fax:
Mailing address:
  • Phone: 412-582-5869
  • Fax: 904-494-6467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN319135L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN44538
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: