Provider Demographics
NPI:1326035361
Name:PADALINO, BETH ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:PADALINO
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: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 1:2006 LIMESTONE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5553
Practice Address - Country:US
Practice Address - Phone:302-995-1860
Practice Address - Fax:302-995-5421
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0018466163W00000X
PARN283292L163W00000X
DEL6-0A00283367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP00728373OtherRAILROAD MEDICARE PTAN
047037OtherAANA ID#
DE137389Medicare PIN