Provider Demographics
NPI:1043214984
Name:FANG, GUISHU (CRNA)
Entity type:Individual
Prefix:
First Name:GUISHU
Middle Name:
Last Name:FANG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:GUI-SHU
Other - Middle Name:
Other - Last Name:FANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 650782
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0782
Mailing Address - Country:US
Mailing Address - Phone:302-733-0806
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:250 S 21ST ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3851
Practice Address - Country:US
Practice Address - Phone:610-250-4303
Practice Address - Fax:610-250-4804
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN327139L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102305810Medicaid
NY444601-1OtherREGISTERED PROFESSIONAL NURSE
PA3739532000OtherIBC
PAFA2091090OtherHIGHMARK BLUE SHIELD
PA072055OtherAANA #
PAP00724820OtherRAILROAD MEDICARE PTAN
PA102305810Medicaid