Provider Demographics
NPI:1346237278
Name:COFFINGER, CAROL (CRNA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:COFFINGER
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 1:1245 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 1:17TH & CHEW STREET
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102
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:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN178298L163W00000X
PA020059367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1543291OtherGATEWAY
PA1027800930001Medicaid
PA1343232OtherKHP CENTRAL
PA2035898000OtherINDEP. BLUE CROSS
PA82838OtherGEISINGER
PA1343232OtherHIGHMARK
PA1343232OtherFIRST PRIORITY
PA9244426OtherAETNA
PA03221701OtherCAPITAL ADVANTAGE
PA11744000OtherCAQH
PA9244426OtherAETNA
PA2035898000OtherINDEP. BLUE CROSS
PA1343232OtherKHP CENTRAL