Provider Demographics
NPI:1710923404
Name:AUSTIN, JEANNETTE (CRNA)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JEANNETTE
Other - Middle Name:
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:2101 S BEVERLY GLEN BLVD PH 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6076
Mailing Address - Country:US
Mailing Address - Phone:970-618-4500
Mailing Address - Fax:
Practice Address - Street 1:6041 CADILLAC AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-1702
Practice Address - Country:US
Practice Address - Phone:323-857-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA420067367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67338054Medicaid
COU7698Medicare ID - Type Unspecified