Provider Demographics
NPI:1881970002
Name:PORTENLANGER, PAUL J (CRNA)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:J
Last Name:PORTENLANGER
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 1:400 N TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4523
Mailing Address - Country:US
Mailing Address - Phone:412-956-9925
Mailing Address - Fax:
Practice Address - Street 1:400 N TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4523
Practice Address - Country:US
Practice Address - Phone:412-956-9925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN 348512-L163W00000X
HIRN 53202163W00000X
OHRN 270188163W00000X
PA348512367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered