MEDICARE: BENITA TROTTER 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-222181-L	PA

General Provider Information

NPI Number	:	1639175359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENITA TROTTER CRNA

Provider Business Mailing Address
First Line	:	2450W HUNTING PARK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1302
Country	:	US
Telephone Number	:	215-707-3911
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 EAST ALLEGHENY AVENUE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-0001
Country	:	US
Telephone Number	:	215-291-3000
Fax Number	:

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	08/19/2015

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