Healthcare Provider Details

I. General information

NPI: 1346260106
Provider Name (Legal Business Name): BIANCA B MOXIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BIANCA B MCNULTY CRNA

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 HOWARD AVE
ALTOONA PA
16601-4804
US

IV. Provider business mailing address

1701 12TH AVE SUITE G2
ALTOONA PA
16601-3100
US

V. Phone/Fax

Practice location:
  • Phone: 814-943-5901
  • Fax: 814-943-3429
Mailing address:
  • Phone: 814-943-5901
  • Fax: 814-943-3429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN200057L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: