Provider Demographics
NPI:1467415232
Name:JERDON, EILEEN JESSICA (CRNA)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:JESSICA
Last Name:JERDON
Suffix:
Gender:F
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:PO BOX 947
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-0947
Mailing Address - Country:US
Mailing Address - Phone:717-263-5562
Mailing Address - Fax:717-263-1566
Practice Address - Street 1:90 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-6343
Practice Address - Country:US
Practice Address - Phone:570-524-2722
Practice Address - Fax:570-524-0362
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN231672L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007689Medicare ID - Type Unspecified