Individual
JENNIFER LARAE HEAVENSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1805 N CALIFORNIA ST STE 101A, STOCKTON, CA 95204-6032
(209) 948-3241
Mailing address
1800 HARRISON ST, 7TH FLOOR, OAKLAND, CA 94612-3466
(510) 625-6262
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4011
CA
Other
Enumeration date
06/01/2011
Last updated
04/17/2025
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