Basic Information
| Provider Information | |||||||||
| NPI: | 1730176629 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | CHARLENE | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 S 18TH STREET | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181045622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106288372 | ||||||||
| FaxNumber: | 6106288648 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 N 17TH ST | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181045052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104029099 | ||||||||
| FaxNumber: | 6104029029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 11/24/2015 | ||||||||
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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 | RN266339L | PA | N | Nursing Service Providers | Registered Nurse | 367500000X | 040491 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 0063046 | 01 | PA | FIRST PRIORITY | OTHER | 0063046 | 01 | PA | HIGHMARK | OTHER | 0063046 | 01 | PA | KHP CENTRAL | OTHER | 9699193 | 01 | PA | AETNA | OTHER | 0070312970003 | 05 | PA | MEDICAID | 01484202 | 01 | PA | CAPITAL ADVANTAGE | OTHER | 0718259000 | 01 | PA | INDEP. BLUE CROSS | OTHER | 11766001 | 01 | PA | CAQH | OTHER | 1585085 | 01 | PA | GATEWAY | OTHER | 82832 | 01 | PA | GEISINGER | OTHER |