Healthcare Provider Details

I. General information

NPI: 1871528141
Provider Name (Legal Business Name): SUZANNE MULVEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 3RD AVE
KINGSTON PA
18704-5809
US

IV. Provider business mailing address

PO BOX 1587
KINGSTON PA
18704-0587
US

V. Phone/Fax

Practice location:
  • Phone: 570-331-0880
  • Fax: 570-331-0220
Mailing address:
  • Phone: 570-331-0880
  • Fax: 570-331-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number036231
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: