1558343855 NPI number — ROBIN E. EYSTER CRNA

Table of content: CHRISTY TROTTER (NPI 1578250353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558343855 NPI number — ROBIN E. EYSTER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EYSTER
Provider First Name:
ROBIN
Provider Middle Name:
E.
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:
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 Information

NPI Number:
1558343855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 790071
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63179-0071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-549-2380
Provider Business Mailing Address Fax Number:
314-569-5974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 FAME AVE STE 130
Provider Second Line Business Practice Location Address:
HILLSIDE II, QUAD D
Provider Business Practice Location Address City Name:
HANOVER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17331-1587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-633-1600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2005

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:  RN240739L , 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: 50090038 . This is a "CAPITAL BC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101299656 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".