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General NPI Number Information
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NPI Number | 1225596661
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Entity Type | Individual
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Provider Name | JESSICA NICHOLE EWALT CRNA
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Gender | Female
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Dates
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Enumeration Date | 03/05/2019
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Last Update Date | 03/05/2019
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Provider Practice Location Address
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Address Line | 4700 WATERS AVE
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City | SAVANNAH
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State | GA
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Zip | 31404-6220
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Country | US
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Telephone | 912-350-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 3 WOODCOCK RD UNIT 4301
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City | SAVANNAH
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State | GA
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Zip | 31404-1096
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Country | US
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Telephone | 708-921-7340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN282208
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License Number State | GA
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