Provider Demographics
NPI:1629544333
Name:STAUN, JEANNA (CRNA)
Entity Type:Individual
Prefix:
First Name:JEANNA
Middle Name:
Last Name:STAUN
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 1:10500 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10500 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4402
Practice Address - Country:US
Practice Address - Phone:513-865-1111
Practice Address - Fax:513-672-9898
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2019-01-23
Deactivation Date:2019-01-14
Deactivation Code:
Reactivation Date:2019-01-18
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.019813367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered