Provider Demographics
NPI:1972544518
Name:HARTSUFF, JENNI H (CRNA, MSA)
Entity type:Individual
Prefix:
First Name:JENNI
Middle Name:H
Last Name:HARTSUFF
Suffix:
Gender:F
Credentials:CRNA, MSA
Other - Prefix:
Other - First Name:JENNI
Other - Middle Name:LYN
Other - Last Name:HEATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1836 WALNUT HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-2946
Mailing Address - Country:US
Mailing Address - Phone:517-332-6629
Mailing Address - Fax:
Practice Address - Street 1:7910 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4159
Practice Address - Country:US
Practice Address - Phone:260-969-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704178226163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4691098Medicaid