Provider Demographics
NPI:1235275355
Name:JARVIS, DONALD H (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:H
Last Name:JARVIS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 STREET RD
Mailing Address - Street 2:STE 204
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4218
Mailing Address - Country:US
Mailing Address - Phone:215-949-3100
Mailing Address - Fax:215-355-6304
Practice Address - Street 1:1280 BROADCASTING RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3203
Practice Address - Country:US
Practice Address - Phone:610-736-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN193247L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50077441OtherCAPITAL BLUE CROSS, KEYSTONE CENTRAL, SENIOR BLUE
PAP00358889OtherRAILROAD MEDICARE
PA22-1994560OtherHEALTH NET TRICARE
PR23-3020597Medicare ID - Type Unspecified
PA698847Q1RMedicare PIN
PA698847Medicare PIN
PA22-1994560OtherHEALTH NET TRICARE