Healthcare Provider Details

I. General information

NPI: 1265478580
Provider Name (Legal Business Name): CLAIRE E. JENKINS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7915 LAKE MANASSAS DR SUITE 302
GAINESVILLE VA
20155-3258
US

IV. Provider business mailing address

7915 LAKE MANASSAS DR SUITE 302
GAINESVILLE VA
20155-3258
US

V. Phone/Fax

Practice location:
  • Phone: 571-248-0653
  • Fax: 571-248-0658
Mailing address:
  • Phone: 571-248-0653
  • Fax: 571-248-0658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NR09930200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024166767
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: