Healthcare Provider Details

I. General information

NPI: 1154310159
Provider Name (Legal Business Name): ZELL Y MOYER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 ENTERPRISE BLVD
ALLENWOOD PA
17810
US

IV. Provider business mailing address

2553 RIDGE RD
NORTHUMBERLAND PA
17857-8704
US

V. Phone/Fax

Practice location:
  • Phone: 570-966-3000
  • Fax: 570-538-1975
Mailing address:
  • Phone: 570-473-3633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2611492
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: