Healthcare Provider Details

I. General information

NPI: 1841211331
Provider Name (Legal Business Name): KIM E KRICHKO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 STATE ST
ERIE PA
16550
US

IV. Provider business mailing address

PO BOX 6490
ERIE PA
16512-6490
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-2137
  • Fax: 814-877-7049
Mailing address:
  • Phone: 814-480-8732
  • Fax: 814-456-5524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN233216L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number438171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: