Provider Demographics
NPI:1245488261
Name:SIMONETTI, JENNIFER L (CRNA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:SIMONETTI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 A OAK BRANCH DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407
Mailing Address - Country:US
Mailing Address - Phone:336-478-2664
Mailing Address - Fax:336-851-0374
Practice Address - Street 1:705 GREEN VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408
Practice Address - Country:US
Practice Address - Phone:336-478-2664
Practice Address - Fax:336-851-0374
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN135975163W00000X
NC4806367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse