Healthcare Provider Details

I. General information

NPI: 1013829746
Provider Name (Legal Business Name): ELIZABETH ON DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

2132 N 2ND ST APT 2
PHILADELPHIA PA
19122-1655
US

V. Phone/Fax

Practice location:
  • Phone: 215-349-8310
  • Fax:
Mailing address:
  • Phone: 410-603-7712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberRN820729
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberRN820729
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberRN820729
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: