1215371737 NPI number — MRS. NORMA LEE LIA CRNA

Table of content: JESSICA SKOGLUND-WILLIAMS (NPI 1083131528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215371737 NPI number — MRS. NORMA LEE LIA CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIA
Provider First Name:
NORMA
Provider Middle Name:
LEE
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:
SMITH
Provider Other First Name:
NORMA
Provider Other Middle Name:
LEE
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:
1215371737
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 FRIENDSHIP AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15224-1722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-578-5323
Provider Business Mailing Address Fax Number:
412-605-6425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 FRIENDSHIP AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15224-1722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-578-5323
Provider Business Practice Location Address Fax Number:
412-605-6425
Provider Enumeration Date:
04/26/2013

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:  RN507673L , 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)

  • Identifier: 12574685 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 102851220 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1215371737 . This is a "NPI" identifier . This identifiers is of the category "OTHER".