Provider Demographics
NPI:1760778088
Name:WERNER, MARK B II (CRNA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:B
Last Name:WERNER
Suffix:II
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1245 S CEDAR CREST BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-8896
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:610-402-8896
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN569068163W00000X
PA087956367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1599789OtherGATEWAY
PAP01067607OtherRAILROAD MEDICARE
PA2631278OtherHIGHMARK
PA3842461000OtherIBC
PA2631278OtherFIRST PRIORITY
PA9360690OtherAETNA
PA1027812880001Medicaid
PA149542OtherGEISINTER
PA12254842OtherCAQH
PA50101421OtherCAPITAL ADVANTAGE
PA1599789OtherGATEWAY
PAP01067607Medicare PIN