Provider Demographics
NPI:1285866491
Name:PRESCOTT, JANELLE B (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:B
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:JANELLE
Other - Middle Name:
Other - Last Name:BASTIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 3750
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110-3750
Mailing Address - Country:US
Mailing Address - Phone:800-748-4868
Mailing Address - Fax:770-701-6676
Practice Address - Street 1:3000 N TRIUMPH BLVD
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4999
Practice Address - Country:US
Practice Address - Phone:385-345-3000
Practice Address - Fax:770-701-6676
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN66063163W00000X
UT5284404-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse