Healthcare Provider Details

I. General information

NPI: 1386648368
Provider Name (Legal Business Name): CHERYL MIERAU BARCOSKI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 BRIGHTON ST SUITE 202
BETHLEHEM PA
18015-1273
US

IV. Provider business mailing address

102 HILLCREST DR
GOULDSBORO PA
18424-9419
US

V. Phone/Fax

Practice location:
  • Phone: 610-954-5810
  • Fax: 610-954-5480
Mailing address:
  • Phone: 570-842-1254
  • Fax: 570-842-5878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN263770L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: