MEDICARE: MR. JEFFREY SCOTT JEDYNAK CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	R172865	MD
2	367500000X	Certified Registered Nurse Anesthetist	CRNA000456	NV

General Provider Information

NPI Number	:	1154414373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY SCOTT JEDYNAK CRNA

Provider Business Mailing Address
First Line	:	9260 W SUNSET RD
Second Line	:	STE. 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4858
Country	:	US
Telephone Number	:	702-255-3547
Fax Number	:	702-921-2419

Provider Business Practice Location Address
First Line	:	9260 W SUNSET RD
Second Line	:	STE. 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4858
Country	:	US
Telephone Number	:	702-255-3547
Fax Number	:	702-921-2419

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	01/31/2017

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Directions to “ MR. JEFFREY SCOTT JEDYNAK CRNA” Practice Location

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