Healthcare Provider Details

I. General information

NPI: 1760207377
Provider Name (Legal Business Name): MADELEINE A MISUS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OLD YORK RD
ABINGTON PA
19001-3720
US

IV. Provider business mailing address

547 ACORN ST
PHILADELPHIA PA
19128-2502
US

V. Phone/Fax

Practice location:
  • Phone: 215-481-2000
  • Fax:
Mailing address:
  • Phone: 610-937-0234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number160341
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: