Provider Demographics
NPI:1003863184
Name:STACHNICK, ANDREA B (CRNA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:B
Last Name:STACHNICK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 JUNE LN
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1407
Mailing Address - Country:US
Mailing Address - Phone:570-347-8452
Mailing Address - Fax:
Practice Address - Street 1:746 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1624
Practice Address - Country:US
Practice Address - Phone:570-348-7127
Practice Address - Fax:570-340-4911
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN173958L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA012398Medicare ID - Type UnspecifiedPROVIDER NUMBER