Provider Demographics
NPI:1447255443
Name:LATONA, PHILIP M (CRNA)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:M
Last Name:LATONA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 JOHNSONBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3417
Mailing Address - Country:US
Mailing Address - Phone:814-788-8000
Mailing Address - Fax:
Practice Address - Street 1:763 JOHNSONBURG ROAD
Practice Address - Street 2:ERPG ANESTHESIA SERVICES
Practice Address - City:ST. MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857
Practice Address - Country:US
Practice Address - Phone:814-788-8569
Practice Address - Fax:814-788-8387
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN243105L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101281965Medicaid
PA36722OtherCRNA LICENSE
PA36722OtherCRNA LICENSE