Provider Demographics
NPI:1184707267
Name:MCGINNIS, SANDRA DIANE (CRNA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:DIANE
Last Name:MCGINNIS
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 1:101 HAMPTON WAY
Mailing Address - Street 2:
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754-9120
Mailing Address - Country:US
Mailing Address - Phone:570-433-4260
Mailing Address - Fax:
Practice Address - Street 1:101 HAMPTON WAY
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-9120
Practice Address - Country:US
Practice Address - Phone:570-433-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN150218L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00186187OtherRAILROAD MEDICARE
S06009Medicare UPIN
PAP00186187OtherRAILROAD MEDICARE