Basic Information
| Provider Information | |||||||||
| NPI: | 1710957774 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEAL | ||||||||
| FirstName: | ARTHUR | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 797 | ||||||||
| Address2: | |||||||||
| City: | SCRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703467797 | ||||||||
| FaxNumber: | 5703429802 | ||||||||
| Practice Location | |||||||||
| Address1: | 1822 MULBERRY ST | ||||||||
| Address2: | |||||||||
| City: | SCRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703467797 | ||||||||
| FaxNumber: | 5703429802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 04/02/2008 | ||||||||
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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 | 367500000X | 17693 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 0073973480002 | 05 | PA | MEDICAID |