Provider Demographics
NPI:1285786285
Name:JENNINGS, MARIA D (CRNA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:D
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:632 N 12TH ST # 230
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-1651
Mailing Address - Country:US
Mailing Address - Phone:270-227-6405
Mailing Address - Fax:
Practice Address - Street 1:632 N 12TH ST # 230
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-1651
Practice Address - Country:US
Practice Address - Phone:270-227-6405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004443367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered