Provider Demographics
NPI:1568436376
Name:SIMKO, PAULETTE L (CRNA)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:L
Last Name:SIMKO
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 1:1245 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:2006-02-16
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-304471-L163W00000X
PA075028367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2626489000OtherIBC
PA11766033OtherCAQH
PA1580140OtherGATEWAY
PA97453OtherGEISINGER
PA1789398OtherFIRST PRIORITY
PA50055230OtherCAPITAL ADVANTAGE
PA1027555820005Medicaid
PA9531499OtherAETNA
PA1789398OtherHIGHMARK BLUE SHIELD
PA50055230OtherKEYSTONE CENTRAL
PA97453OtherGEISINGER
PA2626489000OtherIBC
PA097998QCYMedicare PIN