Provider Demographics
NPI:1669493151
Name:MCANULTY, WILLIAM J (CRNA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:MCANULTY
Suffix:
Gender:M
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:PO BOX 6490
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16512-6490
Mailing Address - Country:US
Mailing Address - Phone:814-480-8732
Mailing Address - Fax:814-456-5524
Practice Address - Street 1:201 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550-0002
Practice Address - Country:US
Practice Address - Phone:814-877-2317
Practice Address - Fax:814-877-7049
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN202959L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA787713Medicare ID - Type UnspecifiedPA MEDICARE#
S22089Medicare UPIN