Provider Demographics
NPI:1689641078
Name:ANGELO, MARIA (CRNA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:ANGELO
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 1:555 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2250
Mailing Address - Country:US
Mailing Address - Phone:717-544-5511
Mailing Address - Fax:
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-544-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN322319L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50060162OtherCAPITAL BLUE CROSS
PA2638696000OtherINDEPENDENCE BLUE CROSS
PA50060162OtherKEYSTONE HEALTH PLAN CENTRAL
PA7532807OtherAETNA-NON HMO
PA001802355OtherHIGHMARK
PA106577OtherGEISINGER
PAP00311703OtherRR MEDICARE
PA50060162OtherCAPITAL BLUE CROSS