Provider Demographics
NPI:1225024888
Name:MUETTERTIES, BONNIE P (CRNA)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:P
Last Name:MUETTERTIES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:L
Other - Last Name:PANCZNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 650782
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0782
Mailing Address - Country:US
Mailing Address - Phone:302-733-0806
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:175 E CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-2284
Practice Address - Country:US
Practice Address - Phone:610-595-6000
Practice Address - Fax:877-329-2370
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN208761L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
031377OtherAANA NUMBER
PAP00678824OtherRAILROAD MEDICARE
PA102336093Medicaid
031377OtherAANA NUMBER