Provider Demographics
NPI:1174524961
Name:MICHELANGELO, JENNIFER M (CRNA, MS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:MICHELANGELO
Suffix:
Gender:F
Credentials:CRNA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 S BEESON AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-4249
Mailing Address - Country:US
Mailing Address - Phone:412-582-5869
Mailing Address - Fax:904-494-6467
Practice Address - Street 1:192 S BEESON AVE
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-4249
Practice Address - Country:US
Practice Address - Phone:412-582-5869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN319135L367500000X
WVAPRN44538367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA065631Medicare ID - Type Unspecified