Basic Information
Provider Information
NPI: 1942512520
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MORLOK
FirstName: ANDREA
MiddleName: P
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: PAPAHARIS
OtherFirstName: ANDREA
OtherMiddleName: M
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: CRNA
OtherLastNameType: 1
Mailing Information
Address1: 51 N 39TH ST
Address2: 223 WRIGHT/SAUNDERS
City: PHILADELPHIA
State: PA
PostalCode: 191042640
CountryCode: US
TelephoneNumber: 2156628244
FaxNumber:  
Practice Location
Address1: 51 N 39TH ST
Address2: 223 WRIGHT SAUDERS
City: PHILADELPHIA
State: PA
PostalCode: 191042640
CountryCode: US
TelephoneNumber: 2156628244
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/12/2010
LastUpdateDate: 10/26/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XRN565908PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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