Healthcare Provider Details

I. General information

NPI: 1376719187
Provider Name (Legal Business Name): JESSICA MARIE HEANEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 JOE SWEET RD
CHEPACHET RI
02814-1924
US

IV. Provider business mailing address

128 JOE SWEET RD
CHEPACHET RI
02814-1924
US

V. Phone/Fax

Practice location:
  • Phone: 401-644-6548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA36665
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN272211
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: