MEDICARE: MS. STEFANIE A. REPICE 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	26NR11400200	NJ

General Provider Information

NPI Number	:	1518186386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEFANIE A. REPICE CRNA

Provider Business Mailing Address
First Line	:	60 ROCK RD E
Second Line	:
City	:	GREEN BROOK
State	:	NJ
Zip	:	08812-2135
Country	:	US
Telephone Number	:	908-754-0630
Fax Number	:	973-972-2357

Provider Business Practice Location Address
First Line	:	60 ROCK RD E
Second Line	:
City	:	GREEN BROOK
State	:	NJ
Zip	:	08812-2135
Country	:	US
Telephone Number	:	908-754-0630
Fax Number	:	973-972-2357

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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