=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609174333
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN MARIE SHINGLEDECKER CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2011
-----------------------------------------------------
Last Update Date | 03/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1211 WILMINGTON AVE
-----------------------------------------------------
City | NEW CASTLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16105-2516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-656-4092
-----------------------------------------------------
Fax | 724-269-9476
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 MOTOR INN DR SUITE 310
-----------------------------------------------------
City | GIRARD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44420-2420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-824-4096
-----------------------------------------------------
Fax | 724-269-9476
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN349335L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN276058
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 086375
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------