Provider Demographics
NPI:1891782116
Name:WIDNER, CHRISTOPHER M (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:WIDNER
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 1:24 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5622
Mailing Address - Country:US
Mailing Address - Phone:610-628-8372
Mailing Address - Fax:610-628-8372
Practice Address - Street 1:1736 W HAMILTON ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5656
Practice Address - Country:US
Practice Address - Phone:610-628-8372
Practice Address - Fax:610-628-8648
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN526740L163W00000X
PA072870367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2001257OtherKHP CENTRAL
PA50045497OtherCAPITAL ADVANTAGE
PA1682106OtherHIGHMARK
PA2355742000OtherINDEP.BLUE CROSS
PAP00238194OtherRAILROAD
PA90782OtherGEISINGER
PAP00238194OtherRAILROAD
PA90782OtherGEISINGER