Individual
JENNI H HARTSUFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA, MSA
Contact information
Practice address
7910 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4159
(260) 969-6200
Mailing address
1836 WALNUT HEIGHTS DR, EAST LANSING, MI 48823-2946
(517) 332-6629
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704178226
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704178226
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4691098
—
MI
Enumeration date
06/08/2006
Last updated
11/14/2012
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