1932491115 NPI number — CHRISTY L STEVENS CRNA

Table of content: CHRISTY L STEVENS CRNA (NPI 1932491115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932491115 NPI number — CHRISTY L STEVENS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEVENS
Provider First Name:
CHRISTY
Provider Middle Name:
L
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:
EISENHAUER
Provider Other First Name:
CHRISTY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932491115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 N DUKE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17602-2250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-544-5511
Provider Business Mailing Address Fax Number:
717-544-7157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 N DUKE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17602-2250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-544-5511
Provider Business Practice Location Address Fax Number:
717-544-7157
Provider Enumeration Date:
05/06/2011

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:  RN519435L , 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)