Provider Demographics
NPI:1245478981
Name:NILSON, JANE LEANNE (CRNA)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:LEANNE
Last Name:NILSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:LEANNE
Other - Last Name:GINGERICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 WHITE TAIL DR
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:TX
Mailing Address - Zip Code:79562-3827
Mailing Address - Country:US
Mailing Address - Phone:325-370-8998
Mailing Address - Fax:325-672-9869
Practice Address - Street 1:1317 N 8TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-4145
Practice Address - Country:US
Practice Address - Phone:325-676-0557
Practice Address - Fax:325-672-9869
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX634600367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L9115Medicare PIN