Provider Demographics
NPI:1033104609
Name:HOLWEGER, JEFFRY M (CRNA)
Entity Type:Individual
Prefix:
First Name:JEFFRY
Middle Name:M
Last Name:HOLWEGER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4128 FORT HENRY DR # D-226
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2260
Mailing Address - Country:US
Mailing Address - Phone:423-426-2121
Mailing Address - Fax:
Practice Address - Street 1:4128 FORT HENRY DR # D-226
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-2260
Practice Address - Country:US
Practice Address - Phone:423-426-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9215367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered