Provider Demographics
NPI:1982141347
Name:GOLDBERG, JENNY (CRNA)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:YAMASAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 DIETZ ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-9713
Mailing Address - Country:US
Mailing Address - Phone:808-778-2566
Mailing Address - Fax:
Practice Address - Street 1:110 PINE GROVE CMNS
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5151
Practice Address - Country:US
Practice Address - Phone:717-741-5257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA648013367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered