Provider Demographics
NPI:1821394065
Name:VIEIRA, JEAN P (CRNA)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:P
Last Name:VIEIRA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NOTTINGHAM TER
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3110
Mailing Address - Country:US
Mailing Address - Phone:973-634-4242
Mailing Address - Fax:
Practice Address - Street 1:10 NOTTINGHAM TER
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3110
Practice Address - Country:US
Practice Address - Phone:973-634-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY614061-1367500000X
NJ26NJ00319700367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered