Provider Demographics
NPI:1518987015
Name:LENT, JENNIFER KAY (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KAY
Last Name:LENT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:KAY
Other - Last Name:MIILAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1782 RED FOX DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-6665
Mailing Address - Country:US
Mailing Address - Phone:907-750-2220
Mailing Address - Fax:
Practice Address - Street 1:2500 S WOODWORTH LOOP
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8984
Practice Address - Country:US
Practice Address - Phone:907-861-6630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK283367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH56522Medicare PIN