Provider Demographics
NPI:1104867332
Name:MINTZER, AMY JO (CRNA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:MINTZER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JO
Other - Last Name:DUNMIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:PO BOX 3127
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 HIGH ST
Practice Address - Street 2:WILLIAMSPORT HOSPITAL & MEDICAL CENTER
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3198
Practice Address - Country:US
Practice Address - Phone:570-321-2385
Practice Address - Fax:570-321-2479
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN263988L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012634090004Medicaid
PA0012634090005Medicaid
PA50494OtherGEISINGER HEALTH PLAN
PA0012634090006Medicaid
PA50494OtherGEISINGER HEALTH PLAN
PA0012634090004Medicaid
PA031325Medicare PIN