Healthcare Provider Details

I. General information

NPI: 1043214984
Provider Name (Legal Business Name): GUISHU FANG CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GUI-SHU FANG

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S 21ST ST
EASTON PA
18042-3851
US

IV. Provider business mailing address

PO BOX 650782
DALLAS TX
75265-0782
US

V. Phone/Fax

Practice location:
  • Phone: 610-250-4303
  • Fax: 610-250-4804
Mailing address:
  • Phone: 302-733-0806
  • Fax: 302-733-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN327139L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: