Provider Demographics
NPI:1295103091
Name:MCNULTY, JANNA DONGELL (CRNA)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:DONGELL
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JANNA
Other - Middle Name:
Other - Last Name:DONGELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:5414 FRIENDLY MANOR DR
Mailing Address - Street 2:APT P
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4354
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-1004
Practice Address - Country:US
Practice Address - Phone:859-323-5956
Practice Address - Fax:859-323-1080
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC108398367500000X
KY3016694367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered