Provider Demographics
NPI:1134434962
Name:FYE, JENELLE LYNN (CRNA)
Entity type:Individual
Prefix:MRS
First Name:JENELLE
Middle Name:LYNN
Last Name:FYE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JENELLE
Other - Middle Name:LYNN
Other - Last Name:BIGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3204 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-2306
Mailing Address - Country:US
Mailing Address - Phone:810-334-9006
Mailing Address - Fax:
Practice Address - Street 1:1221 PINE GROVE AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3511
Practice Address - Country:US
Practice Address - Phone:810-987-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704243706163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse