Healthcare Provider Details

I. General information

NPI: 1013958081
Provider Name (Legal Business Name): LIZABETH DILLA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 STATE ST
ERIE PA
16550-0002
US

IV. Provider business mailing address

4211 OLD STATE RD
EDINBORO PA
16412-1152
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-2137
  • Fax: 814-877-7049
Mailing address:
  • Phone: 571-777-5102
  • Fax: 703-563-6256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN269683L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN178813
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN269683L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: