Provider Demographics
NPI:1356307219
Name:JASIENIECKI, DENNIS (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:JASIENIECKI
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 1:4309 W MEDICAL CENTER DR STE A201
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8411
Mailing Address - Country:US
Mailing Address - Phone:815-385-0084
Mailing Address - Fax:815-385-8968
Practice Address - Street 1:4309 W MEDICAL CENTER DR STE A201
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8411
Practice Address - Country:US
Practice Address - Phone:815-385-0084
Practice Address - Fax:815-385-8968
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-162868/209000222367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered