Individual
MR. CODY OWEN BACKENSTOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
421 CHEW ST, ALLENTOWN, PA 18102-3406
(610) 776-4200
Mailing address
4653 STEVEN LN, WALNUTPORT, PA 18088-9619
(484) 951-3582
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN595267
PA
Other
Enumeration date
03/25/2013
Last updated
03/25/2013
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