Individual
TIMOTHY M. WIRTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1245 S CEDAR CREST BLVD STE 301, ALLENTOWN, PA 18103-6258
(610) 402-8896
(610) 402-9029
Mailing address
1245 S CEDAR CREST BLVD STE 301, ALLENTOWN, PA 18103-6258
(610) 402-8896
(610) 402-9029
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN527078-L
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
91019
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1027793790001
—
PA
01
—
1134471857
GEISINGER
PA
01
—
12447546
CAQH
PA
01
—
1613616
GATEWAY
PA
01
—
2745893
FIRST PRIORITY
PA
01
—
3888598000
IND. BLUE CROSS
PA
01
—
50111779
CAPITAL ADVANTAGE
PA
01
—
9551934
AETNA
PA
Enumeration date
10/04/2012
Last updated
03/25/2013
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