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General NPI Number Information
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NPI Number | 1497086912
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Entity Type | Individual
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Provider Name | JENNIFER PEDERSEN CRNA
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Gender | Female
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Dates
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Enumeration Date | 01/22/2010
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 1850 N CENTRAL AVE STE 1600
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City | PHOENIX
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State | AZ
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Zip | 85004-4633
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Country | US
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Telephone | 602-262-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 645 E MISSOURI AVE STE 300
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City | PHOENIX
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State | AZ
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Zip | 85012-1351
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Country | US
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Telephone | 602-262-8917
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Fax | 602-262-8890
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704275352
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4704275352
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CRNA1062
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License Number State | AZ
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