Provider Demographics
NPI:1417901588
Name:CRITZER, LINDA SUE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:SUE
Last Name:CRITZER
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 1:360 RAMBLING WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3516
Mailing Address - Country:US
Mailing Address - Phone:610-328-1716
Mailing Address - Fax:610-933-4080
Practice Address - Street 1:7918 MAIN STREET, SUITE #204
Practice Address - Street 2:
Practice Address - City:FOGELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18051
Practice Address - Country:US
Practice Address - Phone:610-366-9536
Practice Address - Fax:610-366-9538
Is Sole Proprietor?:No
Enumeration Date:2006-05-21
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN212620L163W00000X
PA212620L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA233093739OtherTAX ID NUMBER
PA006277N7NMedicare PIN