Provider Demographics
NPI:1811158702
Name:ELSWICK, JENNIFER L (CRNA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:ELSWICK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1235
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-1235
Mailing Address - Country:US
Mailing Address - Phone:423-502-3367
Mailing Address - Fax:423-844-2688
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-2686
Practice Address - Fax:423-844-2688
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA1117861367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered