Healthcare Provider Details

I. General information

NPI: 1487082863
Provider Name (Legal Business Name): MICHAEL TROVATO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 2 BOX 50-1
DALTON PA
18414-9611
US

IV. Provider business mailing address

RR 2 BOX 50-1
DALTON PA
18414-9611
US

V. Phone/Fax

Practice location:
  • Phone: 570-335-2405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number644807
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: