1487625315 NPI number — MS. TRACY L MAUSER CRNA

Table of content: MS. TRACY L MAUSER CRNA (NPI 1487625315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487625315 NPI number — MS. TRACY L MAUSER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAUSER
Provider First Name:
TRACY
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
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:
WOLOSHYN
Provider Other First Name:
TRACY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487625315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1657 STURBRIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEWICKLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15143-8514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-548-3299
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 FRIENDSHIP AVENUE
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:
412-578-1354
Provider Business Practice Location Address Fax Number:
412-578-4981
Provider Enumeration Date:
01/30/2006

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:  RN502087L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0000X , with the licence number: RN502087L , 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: 052378 . This is a "CRNA RECERT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00390174 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: RN502087L . This is a "REGISTERED NURSE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 23273409 . This is a "DRIVERS LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com