Provider Demographics
NPI:1700299062
Name:DESAI, ANITA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 8TH AVE
Mailing Address - Street 2:1ST FLOOR, SUITE 102
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-1883
Mailing Address - Country:US
Mailing Address - Phone:484-526-2100
Mailing Address - Fax:
Practice Address - Street 1:1530 8TH AVE
Practice Address - Street 2:1ST FLOOR, SUITE 102
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-1883
Practice Address - Country:US
Practice Address - Phone:484-526-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP004048N363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics