Healthcare Provider Details

I. General information

NPI: 1992712632
Provider Name (Legal Business Name): STEPHEN BOND CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WALNUT ST. JEFFERSON UNIVERSITY HOSPITAL
PHILADELPHIA PA
19107
US

IV. Provider business mailing address

111 S 11TH ST SUITE 8490
PHILADELPHIA PA
19107-4824
US

V. Phone/Fax

Practice location:
  • Phone: 215-503-1340
  • Fax: 215-503-1342
Mailing address:
  • Phone: 215-955-6161
  • Fax: 215-923-5507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN518992L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: