MEDICARE: JLBREITO EZAIRWAY LLC

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

General Provider Information

NPI Number	:	1295681831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JLBREITO EZAIRWAY LLC

Provider Business Mailing Address
First Line	:	317 BLUE STEM LN
Second Line	:
City	:	ALEDO
State	:	TX
Zip	:	76008-1227
Country	:	US
Telephone Number	:	682-552-8874
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 N MAIN ST
Second Line	:
City	:	HARRISON
State	:	AR
Zip	:	72601-2911
Country	:	US
Telephone Number	:	870-414-4000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JENNIFER BREITO
Credential	:	APRN-CRNA
Telephone Number	:	682-552-8874

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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