Healthcare Provider Details

I. General information

NPI: 1598753741
Provider Name (Legal Business Name): MARY MORAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 W STATE ST
DOYLESTOWN PA
18901-2554
US

IV. Provider business mailing address

610 W GERMANTOWN PIKE
PLYMOUTH MEETING PA
19462-1062
US

V. Phone/Fax

Practice location:
  • Phone: 215-348-1523
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN239681L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: