Healthcare Provider Details

I. General information

NPI: 1134347743
Provider Name (Legal Business Name): CATHERINE ANDREA GERACE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE ANDREA QUIGLEY CRNA

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 E 5TH ST
BAYONNE NJ
07002-4219
US

IV. Provider business mailing address

64 E 5TH ST
BAYONNE NJ
07002-4219
US

V. Phone/Fax

Practice location:
  • Phone: 609-577-2784
  • Fax:
Mailing address:
  • Phone: 609-577-2784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NO12053000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number550093-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ00179000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: