Healthcare Provider Details

I. General information

NPI: 1225024888
Provider Name (Legal Business Name): BONNIE P MUETTERTIES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BONNIE L PANCZNER

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 E CHESTER PIKE
RIDLEY PARK PA
19078-2284
US

IV. Provider business mailing address

PO BOX 650782
DALLAS TX
75265-0782
US

V. Phone/Fax

Practice location:
  • Phone: 610-595-6000
  • Fax: 877-329-2370
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 NumberRN208761L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: