Healthcare Provider Details

I. General information

NPI: 1134192933
Provider Name (Legal Business Name): PETER DAVID EATON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 HARRISBURG PIKE SUITE 323
LANCASTER PA
17601
US

IV. Provider business mailing address

1940 HANS HERR DR
WILLOW STREET PA
17584-9537
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-3500
  • Fax:
Mailing address:
  • Phone: 717-464-3260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN335386L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: