Healthcare Provider Details

I. General information

NPI: 1518353010
Provider Name (Legal Business Name): KAYLA CARUSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 BOULDER DR APT 406
HERMANTOWN MN
55811-1596
US

IV. Provider business mailing address

515 BOULDER DR APT 406
HERMANTOWN MN
55811-1596
US

V. Phone/Fax

Practice location:
  • Phone: 412-417-2597
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: