Provider Demographics
NPI:1588801617
Name:JENSEN, BREEANN E (CRNA)
Entity type:Individual
Prefix:
First Name:BREEANN
Middle Name:E
Last Name:JENSEN
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 1:1245 S CEDAR CREST BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-9099
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-402-9099
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN56383163W00000X
PA081277367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022762260002Medicaid
PA11954063OtherCAQH
PA125781OtherGEISINGER
PA50084932OtherCAPITAL ADVANTAGE
PA1583457OtherGATEWAY
PA2088534OtherFIRST PRIORITY
PA3690861000OtherIBC
PA9172321OtherAETNA
PA2088534OtherHIGHMARK
PA1583457OtherGATEWAY
PAP00767004Medicare PIN