Provider Demographics
NPI:1669457446
Name:CHARNEY, JEANNE A (CRNA)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:A
Last Name:CHARNEY
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:PO BOX 765
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-0765
Mailing Address - Country:US
Mailing Address - Phone:909-580-2440
Mailing Address - Fax:909-889-7034
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:ANESTHESIA DEPARTMENT, 2ND FLOOR
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1819
Practice Address - Country:US
Practice Address - Phone:909-580-2440
Practice Address - Fax:909-889-7034
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN535619367500000X
CA2411367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN5356190Medicaid
CAP76627Medicare UPIN
ZZZ24809ZMedicare ID - Type Unspecified
CARN5356190Medicaid
CAZZZ05015ZMedicare PIN