Healthcare Provider Details

I. General information

NPI: 1285267690
Provider Name (Legal Business Name): KATHRYN ANN VALAZAK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HOSPITAL RD STE 2200
INDIANA PA
15701-3663
US

IV. Provider business mailing address

640 KOLTER DR
INDIANA PA
15701-3570
US

V. Phone/Fax

Practice location:
  • Phone: 724-464-0270
  • Fax: 724-464-0274
Mailing address:
  • Phone: 724-357-7196
  • Fax: 724-357-7279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP021519
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: