Provider Demographics
NPI:1982650305
Name:CRONENWETT, JENNIFER L (CRNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:CRONENWETT
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 1:5404 BUTTERFIELD PL
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:MO
Mailing Address - Zip Code:64804-8870
Mailing Address - Country:US
Mailing Address - Phone:417-439-7448
Mailing Address - Fax:417-782-7831
Practice Address - Street 1:1531 E 32ND ST STE 6
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-9810
Practice Address - Country:US
Practice Address - Phone:417-627-9699
Practice Address - Fax:417-627-9602
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004000338367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00112983OtherRR MEDICARE
OK200020780AMedicaid
KS200252340AMedicaid
MO919028001Medicaid
KS200252340AMedicaid