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General NPI Number Information
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NPI Number | 1508853375
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Entity Type | Individual
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Provider Name | JILL L. HANISAK CRNA
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Gender | Female
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 03/25/2013
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Provider Practice Location Address
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Address Line | 1200 S CEDAR CREST BLVD
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City | ALLENTOWN
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State | PA
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Zip | 18103-6202
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Country | US
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Telephone | 610-402-9080
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Fax | 610-402-9029
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Provider Business Mailing Address
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Address Line | 1245 S CEDAR CREST BLVD SUITE #301
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City | ALLENTOWN
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State | PA
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Zip | 18103-6258
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Country | US
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Telephone | 610-402-9080
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Fax | 610-402-9029
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN240246L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 046891
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License Number State | PA
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