Provider Demographics
NPI:1780664912
Name:WARDEN, NEAL A (CRNA)
Entity Type:Individual
Prefix:MR
First Name:NEAL
Middle Name:A
Last Name:WARDEN
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 1:11180 BROKERS LN
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-9714
Mailing Address - Country:US
Mailing Address - Phone:724-864-7328
Mailing Address - Fax:
Practice Address - Street 1:11180 BROKERS LN
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-9714
Practice Address - Country:US
Practice Address - Phone:724-864-7328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN224804L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA004411RUAMedicare ID - Type Unspecified