Provider Demographics
NPI:1265535397
Name:BENNETHUM, BARBARA E (CRNA)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:E
Last Name:BENNETHUM
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 1:1122 STREET RD
Mailing Address - Street 2:STE 204
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4218
Mailing Address - Country:US
Mailing Address - Phone:215-949-3100
Mailing Address - Fax:215-355-6304
Practice Address - Street 1:SIXTH AND SPRUCE STREETS
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19612-6052
Practice Address - Country:US
Practice Address - Phone:610-988-5089
Practice Address - Fax:610-988-5135
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN192173L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA22-1994560OtherHEALTH NET TRICARE
PA50077117OtherCAPITAL BLUE CROSS, KEYSTONE CENTRAL, SENIOR BLUE
PA020895GDNMedicare PIN
PAP00731388Medicare PIN
PA020895Medicare PIN
PA22-1994560OtherHEALTH NET TRICARE