Provider Demographics
NPI:1790748820
Name:BAKER-WITZEL, SHARON (CRNA)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:BAKER-WITZEL
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:PO BOX 18086
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07191-8086
Mailing Address - Country:US
Mailing Address - Phone:201-943-5991
Mailing Address - Fax:201-943-8733
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:800-991-9133
Practice Address - Fax:201-943-8733
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJN074391367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ009096DDHMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER