Provider Demographics
NPI:1437428547
Name:ALVAREZ, COLEEN PREVOZNIK (CRNA)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:PREVOZNIK
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:COLEEN
Other - Middle Name:
Other - Last Name:PREVOZNIK-ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1245 S CEDAR CREST BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-8896
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:1245 S CEDAR CREST BLVD STE 301
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6258
Practice Address - Country:US
Practice Address - Phone:610-402-8896
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN578028163W00000X
PA89658367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12320856OtherCAQH
PA2678586OtherFIRST PRIORITY
PA9028831OtherAETNA
PA1437428547OtherGEISINGER
PA2678586OtherHIGHMARK
PA1605007OtherGATEWAY
PA3871473000OtherIND. BLUE CROSS
PA50105449OtherCAPITAL ADVANTAGE
PA1027798420001Medicaid
PA1027798420001Medicaid
PA232823QCYMedicare PIN