Provider Demographics
NPI:1225023252
Name:ANTIDORMI, JULIE N (CRNA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:N
Last Name:ANTIDORMI
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 1:1245 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-9099
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-402-9099
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN329751L163W00000X
PA054679367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1432773OtherHIGHMARK
PA1432773OtherKHP CENTRAL
PA1432773OtherFIRST PRIORITY
PA1548383OtherGATEWAY
PA50007027OtherCAPITAL ADVANTAGE
PA11802962OtherCAQH
PA2117574000OtherINDEP. BLUE CROSS
PA9352532OtherAETNA
PA1027801550001Medicaid
PA82829OtherGEISINGER
PA50007027OtherCAPITAL ADVANTAGE
PA11802962OtherCAQH
PA82829OtherGEISINGER