Healthcare Provider Details

I. General information

NPI: 1124009683
Provider Name (Legal Business Name): STEVEN L MUTHLER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7729 HARBOR CT
SLATINGTON PA
18080-3656
US

IV. Provider business mailing address

7729 HARBOR CT
SLATINGTON PA
18080-3656
US

V. Phone/Fax

Practice location:
  • Phone: 610-760-2703
  • Fax: 610-395-9336
Mailing address:
  • Phone: 610-760-2703
  • Fax: 610-395-9336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN235353L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: