Basic Information
| Provider Information | |||||||||
| NPI: | 1003885757 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAST | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 N DUKE ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175445511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 555 N DUKE ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175445511 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2006 | ||||||||
| LastUpdateDate: | 03/30/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN350779L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 001544526 | 01 | PA | HIGHMARK | OTHER | 90996 | 01 | PA | GEISINGER | OTHER | P00054070 | 01 | PA | RR MEDICARE | OTHER | 50055746 | 01 | PA | KEYSTONE HEALTH PLAN CENTRAL | OTHER | 1147552 | 01 | PA | AETNA-HMO | OTHER | 7252729 | 01 | PA | AETNA-NON HMO | OTHER | 2228343000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 50055746 | 01 | PA | CAPITAL BLUE CROSS | OTHER |