1366450694 NPI number — MRS. ALICE MAE DOZZI CRNA

Table of content: MRS. ALICE MAE DOZZI CRNA (NPI 1366450694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366450694 NPI number — MRS. ALICE MAE DOZZI CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOZZI
Provider First Name:
ALICE
Provider Middle Name:
MAE
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:
WILSON
Provider Other First Name:
ALICE
Provider Other Middle Name:
MAE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366450694
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5859 SALTSBURG RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERONA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15147-3311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-793-0802
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 HOLLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADDOCK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15104-1599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-636-5612
Provider Business Practice Location Address Fax Number:
412-636-5689
Provider Enumeration Date:
08/03/2006

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:  RN162687L , 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: RN162687L . This is a "RN LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 021489 . This is a "NATIONAL CRNA #" identifier . This identifiers is of the category "OTHER".




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