Provider Demographics
NPI:1346260106
Name:MOXIN, BIANCA B (CRNA)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:B
Last Name:MOXIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:B
Other - Last Name:MCNULTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1701 12TH AVE
Mailing Address - Street 2:SUITE G2
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-3100
Mailing Address - Country:US
Mailing Address - Phone:814-943-5901
Mailing Address - Fax:814-943-3429
Practice Address - Street 1:620 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4804
Practice Address - Country:US
Practice Address - Phone:814-943-5901
Practice Address - Fax:814-943-3429
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN200057L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001324Medicare ID - Type Unspecified
PAR78633Medicare UPIN