Basic Information
| Provider Information | |||||||||
| NPI: | 1144217316 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YEDLOCK | ||||||||
| FirstName: | RAYMOND | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 S CEDAR CREST BLVD | ||||||||
| Address2: | SUITE #301 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181036258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104029099 | ||||||||
| FaxNumber: | 6104029029 | ||||||||
| Practice Location | |||||||||
| Address1: | 17TH & CHEW STREET | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104029099 | ||||||||
| FaxNumber: | 6104029029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 03/25/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN269524L | PA | N | Nursing Service Providers | Registered Nurse | 367500000X | 040438 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1345054 | 01 | PA | HIGHMARK | OTHER | 2037613000 | 01 | PA | INDEP. BLUE CROSS | OTHER | 03226201 | 01 | PA | CAPITAL ADVANTAGE | OTHER | 1027812230001 | 05 | PA | MEDICAID | 1585282 | 01 | PA | GATEWAY | OTHER | 9358458 | 01 | PA | AETNA | OTHER | 1345054 | 01 | PA | FIRST PRIORITY | OTHER | 11783713 | 01 | PA | CAQH | OTHER | 1345054 | 01 | PA | KHP CENTRAL | OTHER | 72366 | 01 | PA | GEISINGER | OTHER |