Healthcare Provider Details

I. General information

NPI: 1356304257
Provider Name (Legal Business Name): AMY THIMONS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY BENDER CRNA

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DUTCH RIDGE RD
BEAVER PA
15009-9727
US

IV. Provider business mailing address

6225 N. STATE HWY 161 STE. 200
IRVING TX
75038-2241
US

V. Phone/Fax

Practice location:
  • Phone: 724-728-7000
  • Fax: 214-687-9344
Mailing address:
  • Phone: 214-687-0496
  • Fax: 214-687-9344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN-522617-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: