Provider Demographics
NPI:1679912166
Name:DILEO, JENNIFER M (CRNA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:DILEO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:JACQUES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:868 JOE YENNI BLVD
Mailing Address - Street 2:#17
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-4855
Mailing Address - Country:US
Mailing Address - Phone:601-347-6258
Mailing Address - Fax:
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07345367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2338455Medicaid
MS08255369Medicaid
MS08255369Medicaid