Provider Demographics
NPI:1285621045
Name:KRESTYNICK, MICHAEL E (CRNA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:KRESTYNICK
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 1:1245 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-9099
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:2545 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7300
Practice Address - Country:US
Practice Address - Phone:610-402-9099
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN197178L163W00000X
PA027257367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027806380001Medicaid
PA1343814OtherHIGHMARK
PA1343814OtherFIRST PRIORITY
PA2036425000OtherIND. BLUE CROSS
PA11716950OtherCAQH
PA1343814OtherKHP CENTRAL
PA9132448OtherAETNA
PA03223701OtherCAPITAL ADVANTAGE
PA82854OtherGEISINGER
PA1542914OtherGATEWAY
PA82854OtherGEISINGER
PA11716950OtherCAQH
PA616740QCYMedicare PIN