Provider Demographics
NPI:1992866958
Name:NORWOOD, JENNIFER S (CRNA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:NORWOOD
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:PO BOX 84537
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-7201
Mailing Address - Country:US
Mailing Address - Phone:817-334-0530
Mailing Address - Fax:817-334-0235
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:682-885-4045
Practice Address - Fax:682-885-7497
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX605624367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137345809Medicaid
TX10018142OtherAMERIGROUP PIN
1447220850OtherGRP NPI NUMBER
TX171758901Medicaid
TX10018142OtherAMERIGROUP PIN
TX8D3568Medicare PIN
Q37987Medicare UPIN