MEDICARE: MARIA MANTZ 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	677117	NY
2	163W00000X	Registered Nurse	677117	NY
3	163W00000X	Registered Nurse	RN758901	PA
4	163W00000X	Registered Nurse	26NR17557200	NJ

General Provider Information

NPI Number	:	1851225486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA MANTZ CRNA

Provider Business Mailing Address
First Line	:	156 CORLISS AVE APT 107
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-2071
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	156 CORLISS AVE APT 107
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-2071
Country	:	US
Telephone Number	:	718-344-6003
Fax Number	:

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

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/15/2026

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