Provider Demographics
NPI:1871557264
Name:BRANDTONIES, KIM (CRNA)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BRANDTONIES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:899 POPLAR CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2206
Mailing Address - Country:US
Mailing Address - Phone:717-763-0430
Mailing Address - Fax:717-763-9854
Practice Address - Street 1:899 POPLAR CHURCH RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2206
Practice Address - Country:US
Practice Address - Phone:717-763-0430
Practice Address - Fax:717-763-9854
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN537260367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50055787OtherKEYSTONE HEALTH PLAN CENTRAL
PAP00277514OtherRR MEDICARE
PA2353006000OtherINDEPENDENCE BLUE CROSS
PA106594OtherGEISINGER
PA50055787OtherCAPITAL BLUE CROSS
PA7510766OtherAETNA-NON HMO
PA001678873OtherHIGHMARK
PA20053630OtherMERCY
PA7510766OtherAETNA-NON HMO