1366430514 NPI number — MRS. JOANNE DILACQUA CRNA

Table of content: MRS. JOANNE DILACQUA CRNA (NPI 1366430514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366430514 NPI number — MRS. JOANNE DILACQUA CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DILACQUA
Provider First Name:
JOANNE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EDMONDS
Provider Other First Name:
JOANNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366430514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
804 SCOTT NIXON MEMORIAL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30909-2464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-394-4445
Provider Business Mailing Address Fax Number:
706-650-1034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CAPITAL WAY
Provider Second Line Business Practice Location Address:
2ND FLOOR ANESTHESIA OFFICES
Provider Business Practice Location Address City Name:
PENNINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08534-2520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-396-4700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN327603L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 26NJ00267300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 115406RVB . This is a "NATIONAL GOVERNMENT SERVICES (NJ EMPIRE)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 076790Q1R . This is a "READING MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".