Provider Demographics
NPI:1942913942
Name:WILLIMAN, JENNIFER (CRNA)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:WILLIMAN
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 1:2 MONUMENT AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-2109
Mailing Address - Country:US
Mailing Address - Phone:570-899-8533
Mailing Address - Fax:
Practice Address - Street 1:2 MONUMENT AVE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-2109
Practice Address - Country:US
Practice Address - Phone:570-899-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA142841367500000X
PARN661965163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse