Basic Information
| Provider Information | |||||||||
| NPI: | 1154414373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JEDYNAK | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9260 W SUNSET RD | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891484858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022553547 | ||||||||
| FaxNumber: | 7029212419 | ||||||||
| Practice Location | |||||||||
| Address1: | 9260 W SUNSET RD | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891484858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022553547 | ||||||||
| FaxNumber: | 7029212419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 01/31/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R172865 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | CRNA000456 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.