Provider Demographics
NPI:1285631549
Name:KANIA, MARK (CRNA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:KANIA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:517 ASH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509-2903
Mailing Address - Country:US
Mailing Address - Phone:570-969-6100
Mailing Address - Fax:570-983-0267
Practice Address - Street 1:517 ASH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-2903
Practice Address - Country:US
Practice Address - Phone:570-969-6100
Practice Address - Fax:570-983-0267
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARN250001L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA010501M0JMedicare ID - Type Unspecified