1346237278 NPI number — CAROL COFFINGER CRNA

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346237278 NPI number — CAROL COFFINGER CRNA

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

COFFINGER

Provider First Name:

CAROL

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

CRNA

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1346237278

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/25/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1245 S CEDAR CREST BLVD

Provider Second Line Business Mailing Address:

SUITE #301

Provider Business Mailing Address City Name:

ALLENTOWN

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

18103-6258

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

610-402-9099

Provider Business Mailing Address Fax Number:

610-402-9029

Provider First Line Business Practice Location Address:

17TH & CHEW STREET

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ALLENTOWN

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

18102

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

610-402-9099

Provider Business Practice Location Address Fax Number:

610-402-9029

Provider Enumeration Date:

10/05/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 163W00000X , with the licence number:  RN178298L , 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: 020059 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1543291 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1027800930001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1343232 . This is a "KHP CENTRAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2035898000 . This is a "INDEP. BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 82838 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1343232 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1343232 . This is a "FIRST PRIORITY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 9244426 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 03221701 . This is a "CAPITAL ADVANTAGE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 11744000 . This is a "CAQH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".