1225024888 NPI number — BONNIE P MUETTERTIES CRNA

Table of content: BRENDA LAYTON MCGIVERN DO (NPI 1033276035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225024888 NPI number — BONNIE P MUETTERTIES CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUETTERTIES
Provider First Name:
BONNIE
Provider Middle Name:
P
Provider Name Prefix Text:
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:
PANCZNER
Provider Other First Name:
BONNIE
Provider Other Middle Name:
L
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:
1225024888
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:
PO BOX 650782
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75265-0782
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-733-0806
Provider Business Mailing Address Fax Number:
302-733-0854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 E CHESTER PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDLEY PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19078-2284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-595-6000
Provider Business Practice Location Address Fax Number:
877-329-2370
Provider Enumeration Date:
09/20/2005

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:  RN208761L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 031377 . This is a "AANA NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00678824 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 102336093 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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