Healthcare Provider Details

I. General information

NPI: 1104863018
Provider Name (Legal Business Name): ANDREW J. KISKADDEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 CENTRAL AVE
DUNKIRK NY
14048-2599
US

IV. Provider business mailing address

PO BOX 1149
ERIE PA
16512-1149
US

V. Phone/Fax

Practice location:
  • Phone: 716-366-1111
  • Fax: 704-248-5537
Mailing address:
  • Phone: 814-454-8885
  • Fax: 814-456-3856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN531962
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number729433
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: