MEDICARE: JENNIFER L BOURNE 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	APRN.CRNA.11026	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871829291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L BOURNE CRNA

Provider Business Mailing Address
First Line	:	4135 BOARDMAN CANFIELD RD
Second Line	:	SUITE 101
City	:	CANFIELD
State	:	OH
Zip	:	44406-9803
Country	:	US
Telephone Number	:	330-286-5330
Fax Number	:	330-286-5396

Provider Business Practice Location Address
First Line	:	200 E STATE ST
Second Line	:
City	:	ALLIANCE
State	:	OH
Zip	:	44601-4936
Country	:	US
Telephone Number	:	330-596-7227
Fax Number	:	330-596-7214

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

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	04/02/2026

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