Provider Demographics
NPI:1730284183
Name:JEDAMSKI, ELIZABETH ELLEN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ELLEN
Last Name:JEDAMSKI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ELLEN
Other - Last Name:JEDAMSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:COLLEGEDALE
Mailing Address - State:TN
Mailing Address - Zip Code:37315-0368
Mailing Address - Country:US
Mailing Address - Phone:423-236-4455
Mailing Address - Fax:
Practice Address - Street 1:1801 GUNBARREL ROAD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421
Practice Address - Country:US
Practice Address - Phone:423-855-6861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN43185367500000X
TNAPN0000011035367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3621074Medicaid
TN3621074Medicaid