Basic Information
| Provider Information | |||||||||
| NPI: | 1508853375 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANISAK | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | L. | ||||||||
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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: | 6104029080 | ||||||||
| FaxNumber: | 6104029029 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 S CEDAR CREST BLVD | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181036202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104029080 | ||||||||
| FaxNumber: | 6104029029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 03/25/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN240246L | PA | N | Nursing Service Providers | Registered Nurse | 367500000X | 046891 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1546038 | 01 | PA | GATEWAY | OTHER | 0017673800006 | 05 | PA | MEDICAID | 03224201 | 01 | PA | CAPITAL ADVANTAGE | OTHER | 1343791 | 01 | PA | HIGHMARK | OTHER | 1343791 | 01 | PA | KHP CENTRAL | OTHER | 11776573 | 01 | PA | CAQH | OTHER | 1343791 | 01 | PA | FIRST PRIORITY | OTHER | 2036405000 | 01 | PA | INDEP. BLUE CROSS | OTHER | 82851 | 01 | PA | GEISINGER | OTHER | 9573465 | 01 | PA | AETNA | OTHER |