Provider Demographics
NPI:1689648495
Name:MAKIN, JASON P (CRNA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:P
Last Name:MAKIN
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 1:1245 S. CEDAR CREST BLVD.
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103
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-533186163W00000X
PA074745367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1794626OtherFIRST PRIORITY
PA2631636000OtherIBC
PA9669463OtherAETNA
PA1552963OtherGATEWAY
PA1027799870001Medicaid
PA1794626OtherHIGHMARK BLUE SHIELD
PA50055370OtherCAPITAL ADVANTAGE
PA11766023OtherCAQH
PA50055370OtherKEYSTONE CENTRAL
PA2333OtherGEISINGER
PA2631636000OtherIBC
PA1027799870001Medicaid
PAP00281710Medicare PIN