Provider Demographics
NPI:1639147580
Name:DAVIS, JENNIFER R (CRNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:IGNOSH
Other - Suffix:
Other - Last Name Type:Former Name
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:2006-03-08
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN521886-L163W00000X
PA074737367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027826140001Medicaid
PA1802040OtherFIRST PRIORITY
PA1802040OtherHIGHMARK
PA9319456OtherAETNA
PA11776576OtherCAQH
PA1584022OtherGATEWAY
PA2189OtherGEISINGER
PA2638353000OtherIBC
PA50056132OtherCAPITAL ADVANTAGE
PA1027826140001Medicaid
PA2189OtherGEISINGER
PAP00290080Medicare PIN