MEDICARE: GERALD FLORA 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	RN152202L	PA

General Provider Information

NPI Number	:	1518968783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD FLORA CRNA

Provider Business Mailing Address
First Line	:	56 N MOUNTAIN BLVD
Second Line	:
City	:	MOUNTAIN TOP
State	:	PA
Zip	:	18707-1117
Country	:	US
Telephone Number	:	570-474-1130
Fax Number	:	570-474-1174

Provider Business Practice Location Address
First Line	:	56 N MOUNTAIN BLVD
Second Line	:
City	:	MOUNTAIN TOP
State	:	PA
Zip	:	18707-1117
Country	:	US
Telephone Number	:	570-474-1130
Fax Number	:	570-474-1174

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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