Provider Demographics
NPI:1356322267
Name:PRUDENTE, JAMES J (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:J
Last Name:PRUDENTE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 OSTRUM ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:610-954-5810
Mailing Address - Fax:
Practice Address - Street 1:451 W CHEW ST
Practice Address - Street 2:SUITE 409
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3472
Practice Address - Country:US
Practice Address - Phone:610-770-3130
Practice Address - Fax:610-770-3452
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN247428L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
0721521000OtherIBC
50049408OtherCBC
50049408OtherCBC
005348HR2Medicare PIN
0721521000OtherIBC