Provider Demographics
NPI:1063794287
Name:SANTOSTEFANO, JEANA M (CRNA)
Entity type:Individual
Prefix:
First Name:JEANA
Middle Name:M
Last Name:SANTOSTEFANO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JEANA
Other - Middle Name:MARIE
Other - Last Name:SANTOSTEFANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:7 INDEPENDENCE PT STE 300
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4569
Practice Address - Country:US
Practice Address - Phone:864-522-3700
Practice Address - Fax:864-522-3705
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-545749163W00000X
PA88814367500000X
SC25918367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027810180001Medicaid
PA50103563OtherCAPITAL ADVANTAGE
PA2668838OtherFRIST PRIORITY
PAP01010715OtherRAILROAD MEDICARE
PA154820OtherGEISINGER
PA1600126OtherGATEWAY
PA2668838OtherHIGHMARK
PA12296970OtherCAQH
PA3864014000OtherIND. BLUE CROSS
PA9404844OtherAETNA
PA2668838OtherFRIST PRIORITY