Basic Information
Provider Information
NPI: 1699322701
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZBARASCHUK
FirstName: MADISON
MiddleName: CHANDLER
NamePrefix:  
NameSuffix:  
Credential: CRNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 801 OSTRUM ST
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180151000
CountryCode: US
TelephoneNumber: 4845265731
FaxNumber: 8332136428
Practice Location
Address1: 801 OSTRUM ST
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180151000
CountryCode: US
TelephoneNumber: 4845265731
FaxNumber: 8332136428
Other Information
ProviderEnumerationDate: 08/22/2019
LastUpdateDate: 08/22/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XSP020443PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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