1518302256 NPI number — MRS. MICHELENE YASMIN JETER OGAGAN CRNA

Table of content: MRS. MICHELENE YASMIN JETER OGAGAN CRNA (NPI 1518302256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518302256 NPI number — MRS. MICHELENE YASMIN JETER OGAGAN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JETER OGAGAN
Provider First Name:
MICHELENE
Provider Middle Name:
YASMIN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JETER
Provider Other First Name:
MICHELENE
Provider Other Middle Name:
YASMIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518302256
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 LOTHROP ST
Provider Second Line Business Mailing Address:
SUITE 9055 FORBES TOWER
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15213-2536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-647-3087
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 LOTHROP ST
Provider Second Line Business Practice Location Address:
SUITE 200 C-WING
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15213-2536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-647-5909
Provider Business Practice Location Address Fax Number:
412-647-0342
Provider Enumeration Date:
05/08/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN601250 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)