Provider Demographics
NPI:1700174687
Name:PFENDER, JENNIFER MARIE (CRNA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:PFENDER
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 1:3004 LAKEMONT DR
Mailing Address - Street 2:FORBES TOWER SUITE 9055
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-6220
Mailing Address - Country:US
Mailing Address - Phone:724-916-4975
Mailing Address - Fax:
Practice Address - Street 1:200 LORTHROP STREET
Practice Address - Street 2:FORBES TOWER SUITE 9055
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-647-3087
Practice Address - Fax:412-647-4486
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN557146367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGOtherBCBS
FLPENDINGMedicaid
FLPENDINGMedicare PIN