Provider Demographics
NPI:1376536557
Name:HONSAKER, JENNIFER (CRNA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:HONSAKER
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 1:139 GREENTREE CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-7906
Mailing Address - Country:US
Mailing Address - Phone:218-844-3777
Mailing Address - Fax:216-844-3780
Practice Address - Street 1:29017 CEDAR RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-4073
Practice Address - Country:US
Practice Address - Phone:440-460-8000
Practice Address - Fax:440-460-1759
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH46695163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000221249OtherUNISON
OH414981OtherWELLCARE
OH750644OtherBUCKEYE
OH7859973OtherAETNA
OH000000515992OtherANTHEM
OHP00678108OtherMEDICARE RAILROAD
OH0187677Medicaid
OH0583328OtherBCMH
OH0187677Medicaid
OH0583328OtherBCMH