Provider Demographics
NPI:1417941238
Name:STASURAK, ADRIANE CHRISTINE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ADRIANE
Middle Name:CHRISTINE
Last Name:STASURAK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2573 CHANDLEE CT
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8787
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-3062
Practice Address - Country:US
Practice Address - Phone:610-758-3870
Practice Address - Fax:610-758-5833
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAV006755C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA093707KZRMedicare UPIN