Provider Demographics
NPI:1912240763
Name:WARAXA, JENEA ANN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JENEA
Middle Name:ANN
Last Name:WARAXA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:JENEA
Other - Middle Name:ANN
Other - Last Name:KOEHNKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:262-206-1968
Mailing Address - Fax:
Practice Address - Street 1:9200 W. WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:262-206-1968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-30
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI154688-30367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered