Provider Demographics
NPI:1407392152
Name:JAFRATE, JENNA M (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:M
Last Name:JAFRATE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:M
Other - Last Name:KOLISCAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:109 MOUNT WOOD RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2632
Mailing Address - Country:US
Mailing Address - Phone:304-233-2455
Mailing Address - Fax:304-233-6073
Practice Address - Street 1:4000 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2364
Practice Address - Country:US
Practice Address - Phone:740-264-8328
Practice Address - Fax:740-264-8419
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN78999-CRNA367500000X
OHAPRN.CRNA.019411367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0211828Medicaid
OHH474731Medicare PIN