Provider Demographics
NPI:1245227008
Name:EVANS, PAUL J (CRNA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:EVANS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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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:2005-10-05
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARN240222L163W00000X
PA038377367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11766012OtherCAQH
PA9459411OtherAETNA
PA1027803060001Medicaid
PA1344318OtherFIRST PRIORITY
PA1544941OtherGATEWAY
PA03222501OtherCAPITAL ADVANTAGE
PA1344318OtherKHP CENTRAL
PA1344318OtherHIGHMARK
PA2036897000OtherINDEP. BLUE CROSS
PA82841OtherGEISINGER
PA1544941OtherGATEWAY
PA2036897000OtherINDEP. BLUE CROSS
PA11766012OtherCAQH