Healthcare Provider Details

I. General information

NPI: 1922430883
Provider Name (Legal Business Name): JAMIE L. MCGUGAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE L. DAWES CRNA

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

PO BOX 5520
BETHLEHEM PA
18015-0520
US

V. Phone/Fax

Practice location:
  • Phone: 215-208-4163
  • Fax:
Mailing address:
  • Phone: 215-208-4163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN595589
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: