Individual
BONNIE P MUETTERTIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
175 E CHESTER PIKE, RIDLEY PARK, PA 19078-2284
(610) 595-6000
(877) 329-2370
Mailing address
PO BOX 650782, DALLAS, TX 75265-0782
(302) 733-0806
(302) 733-0854
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN208761L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
031377
AANA NUMBER
—
05
—
102336093
—
PA
01
—
P00678824
RAILROAD MEDICARE
PA
Enumeration date
09/20/2005
Last updated
08/28/2012
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