Healthcare Provider Details

I. General information

NPI: 1083672604
Provider Name (Legal Business Name): KIMBERLY M TROJAK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY M TROJAK CRNA

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CONTINENTAL DR SUITE 412
NEWARK DE
19713-4306
US

IV. Provider business mailing address

21 HEARTHSTONE LN
MARLTON NJ
08053-5363
US

V. Phone/Fax

Practice location:
  • Phone: 302-709-4497
  • Fax: 302-733-0854
Mailing address:
  • Phone: 856-797-8470
  • Fax: 302-733-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number23NR07589700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NR07589700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN262198L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: