Provider Demographics
NPI:1922040062
Name:LANDIS, ROBERT KEITH (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KEITH
Last Name:LANDIS
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 1:8292 S RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-9138
Mailing Address - Country:US
Mailing Address - Phone:610-966-3163
Mailing Address - Fax:
Practice Address - Street 1:8292 S RIDGE DR
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-9138
Practice Address - Country:US
Practice Address - Phone:610-966-3163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-254765L163W00000X
PA041740367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1579397OtherHIGHMARK
PA2258727000OtherINDEPENDENCE BLUE CROSS
PA005409QQSMedicare PIN
PA1579397OtherHIGHMARK