Healthcare Provider Details

I. General information

NPI: 1023083110
Provider Name (Legal Business Name): MARY ELLEN ROBERTSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ELLEN SICHAK CRNA

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
CLARION PA
16214-8501
US

IV. Provider business mailing address

669 PINEY RD
CLARION PA
16214-3515
US

V. Phone/Fax

Practice location:
  • Phone: 814-226-9500
  • Fax:
Mailing address:
  • Phone: 412-418-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN296245L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: