Provider Demographics
NPI:1043271372
Name:VIVIAN, CONCETTA M (CRNA)
Entity type:Individual
Prefix:
First Name:CONCETTA
Middle Name:M
Last Name:VIVIAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CONCETTA
Other - Middle Name:M
Other - Last Name:FIGORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 783497
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3497
Mailing Address - Country:US
Mailing Address - Phone:610-395-4044
Mailing Address - Fax:610-395-5693
Practice Address - Street 1:5100 W TILGHMAN ST STE 315
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9166
Practice Address - Country:US
Practice Address - Phone:610-395-4044
Practice Address - Fax:610-395-5693
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN239821L163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00237876OtherRAILROAD MC PROV#
PAP00237876OtherRAILROAD MC PROV#
PAS22070Medicare UPIN