Basic Information
| Provider Information | |||||||||
| NPI: | 1447255443 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LATONA | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | C.R.N.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 763 JOHNSONBURG RD | ||||||||
| Address2: | |||||||||
| City: | SAINT MARYS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158573417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147888000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 763 JOHNSONBURG ROAD | ||||||||
| Address2: | ERPG ANESTHESIA SERVICES | ||||||||
| City: | ST. MARYS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147888569 | ||||||||
| FaxNumber: | 8147888387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 06/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN243105L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 101281965 | 05 | PA | MEDICAID | 36722 | 01 | PA | CRNA LICENSE | OTHER |