=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720353568
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORI B BITTENBENDER CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2012
-----------------------------------------------------
Last Update Date | 03/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1503 N CEDAR CREST BLVD
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18104-2302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-861-8080
-----------------------------------------------------
Fax | 610-861-0854
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2775 SCHOENERSVILLE RD
-----------------------------------------------------
City | BETHLEHEM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18017-7307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-861-8080
-----------------------------------------------------
Fax | 610-861-0854
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | RN589596
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------