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General NPI Number Information
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NPI Number | 1104377282
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Entity Type | Individual
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Provider Name | HEATHER BOSTANCIC CRNA
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Gender | Female
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 10/24/2016
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Provider Practice Location Address
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Address Line | 3401 CIVIC CENTER BOULEVARD SUITE 9329
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4319
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Country | US
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Telephone | 215-590-1858
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Fax | 215-590-1415
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Provider Business Mailing Address
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Address Line | 100 EAST PENN SQUARE THE WANAMAKER BLDG., 9TH FL. N
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City | PHILADELPHIA
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State | PA
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Zip | 19107-3323
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Country | US
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Telephone | 267-425-9300
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Fax | 267-425-9331
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN606709
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License Number State | PA
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