Healthcare Provider Details

I. General information

NPI: 1043294838
Provider Name (Legal Business Name): LISA A. RAWA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 HOSPITAL RD
COAL TOWNSHIP PA
17866-9668
US

IV. Provider business mailing address

4200 HOSPITAL RD
COAL TOWNSHIP PA
17866-9668
US

V. Phone/Fax

Practice location:
  • Phone: 570-644-4259
  • Fax: 570-644-1194
Mailing address:
  • Phone: 570-644-4259
  • Fax: 570-644-1194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN283843L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: