MEDICARE: MS. RUTH ANN STATEWICZ CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN-199288-L	PA

General Provider Information

NPI Number	:	1427039700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RUTH ANN STATEWICZ CRNA

Provider Business Mailing Address
First Line	:	835 HOSPITAL RD
Second Line	:	PO BOX 788
City	:	INDIANA
State	:	PA
Zip	:	15701-3629
Country	:	US
Telephone Number	:	724-357-7009
Fax Number	:	724-357-7414

Provider Business Practice Location Address
First Line	:	835 HOSPITAL RD
Second Line	:	ANESTHESIOLOGY DEPARTMENT
City	:	INDIANA
State	:	PA
Zip	:	15701-3629
Country	:	US
Telephone Number	:	724-357-7218
Fax Number	:	724-357-7475

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	07/08/2007

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