Individual
JENNY R DEFOREEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1640 AIRPORT RD NW, STE. 110, KENNESAW, GA 30144-7038
(678) 202-2074
(678) 290-0479
Mailing address
1984 PEACHTREE RD NW, STE. 515, ATLANTA, GA 30309-5219
(404) 351-1754
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
020068
OH
Other
Enumeration date
03/02/2007
Last updated
09/30/2021
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