Provider Demographics
NPI:1508308545
Name:NZASI, IRENE MUKELI (CRNA)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:MUKELI
Last Name:NZASI
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 1:904 VIOLET TER
Mailing Address - Street 2:
Mailing Address - City:WAVERLY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9203
Mailing Address - Country:US
Mailing Address - Phone:607-722-1584
Mailing Address - Fax:
Practice Address - Street 1:156 CORLISS AVE SUITE 107
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790
Practice Address - Country:US
Practice Address - Phone:607-763-6735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY593856-1163W00000X
PA112399367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1669427456OtherSUSQUEHANA ANESTHESIA AFFILIATES