Provider Demographics
NPI:1376832683
Name:YANARELLA, ANTHONY M (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:M
Last Name:YANARELLA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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 1:175 E CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-2212
Practice Address - Country:US
Practice Address - Phone:215-442-5085
Practice Address - Fax:877-329-2370
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN563713367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102623251Medicaid
DEL1-0034310OtherRN LICENSE
PA050514OtherMEDICARE GROUP #
PA087419OtherAANA NUMBER