=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720476955
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VERONICA LARDANI CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2014
-----------------------------------------------------
Last Update Date | 05/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 JAMES DR
-----------------------------------------------------
City | LEESPORT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19533-8866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-372-0591
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 527 SUMMERCROFT DR
-----------------------------------------------------
City | EXTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19341-3049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-240-2575
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 104881
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------