Provider Demographics
NPI:1558357335
Name:KRYSTOFINSKI, JILL M (CRNA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:KRYSTOFINSKI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1245 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-9099
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-402-9099
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN277643L163W00000X
PA070026367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027795840001Medicaid
PA1466843OtherKHP CENTRAL
PA1466843OtherFIRST PRIORITY
PA9109431OtherAETNA
PA2151119000OtherINDEP. BLUE CROSS
PA1466843OtherHIGHMARK
PA11803035OtherCAQH
PA1580834OtherGATEWAY
PA82856OtherGEISINGER
PA50010797OtherCAPITAL ADVANTAGE
PA50010797OtherCAPITAL ADVANTAGE
PAP87954Medicare UPIN
PA1466843OtherKHP CENTRAL