Provider Demographics
NPI:1639252125
Name:CROWNHART, JENNIFER A (CRNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:CROWNHART
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 1:1780 E APPALACHIAN RD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1718
Mailing Address - Country:US
Mailing Address - Phone:928-699-9448
Mailing Address - Fax:
Practice Address - Street 1:1020 N. SAN FRANCISCO ST.
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-699-9448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN097480367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ394974Medicaid
AZ430053651OtherRAIL ROAD MEDICARE
AZAZ0090910OtherBLUE CROSS BLUE SHIELD
S35279Medicare UPIN
AZ394974Medicaid
Z68641Medicare ID - Type Unspecified