Provider Demographics
NPI:1750378857
Name:QUAGLIO, VIRGINIA M (CRNA)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:M
Last Name:QUAGLIO
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 1:8613 LOCKWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:BREININGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18131-6258
Mailing Address - Country:US
Mailing Address - Phone:412-780-7968
Mailing Address - Fax:
Practice Address - Street 1:8613 LOCKWOOD ROAD
Practice Address - Street 2:
Practice Address - City:BREININGSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18131-6258
Practice Address - Country:US
Practice Address - Phone:412-780-7968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN318366L163W00000X
PA050861367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP11461Medicare UPIN
PA040466Medicare PIN