MEDICARE: MRS. HEATHER A OLDS 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	163W00000X	Registered Nurse	L1-0034155	DE
2	163W00000X	Registered Nurse	0001174340	VA
3	367500000X	Certified Registered Nurse Anesthetist	L6-0A00487	DE
4	367500000X	Certified Registered Nurse Anesthetist	0024166422	VA
5	367500000X	Certified Registered Nurse Anesthetist	RN524068L	PA

General Provider Information

NPI Number	:	1588652069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER A OLDS CRNA

Provider Business Mailing Address
First Line	:	2006 LIMESTONE RD
Second Line	:	SUITE 5
City	:	WILMINGTON
State	:	DE
Zip	:	19808-5553
Country	:	US
Telephone Number	:	302-995-1860
Fax Number	:	302-995-5421

Provider Business Practice Location Address
First Line	:	701 E MARSHALL ST
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-4412
Country	:	US
Telephone Number	:	610-431-5472
Fax Number	:

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	06/04/2018

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