Provider Demographics
NPI:1912923251
Name:FREITAG, ANNA JEAN (CRNA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:JEAN
Last Name:FREITAG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:JEAN
Other - Last Name:MCIVOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:19 E WILLOW GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3425
Mailing Address - Country:US
Mailing Address - Phone:215-242-0691
Mailing Address - Fax:
Practice Address - Street 1:937 E HAVERFORD RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3800
Practice Address - Country:US
Practice Address - Phone:610-525-4966
Practice Address - Fax:610-525-0874
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN28262L367500000X
PARN282862L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered