Provider Demographics
NPI:1740656438
Name:CLEVENGER, JENNIFER LYNN (CRNA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:CLEVENGER
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 1:35 ALBANY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62903-7646
Mailing Address - Country:US
Mailing Address - Phone:618-457-5111
Mailing Address - Fax:618-457-6560
Practice Address - Street 1:35 ALBANY RD
Practice Address - Street 2:SUITE C
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62903-7646
Practice Address - Country:US
Practice Address - Phone:618-457-5111
Practice Address - Fax:618-457-6560
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041375950163W00000X
IL209013295367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse