Healthcare Provider Details

I. General information

NPI: 1497816433
Provider Name (Legal Business Name): ELAINE KLOS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 WATERDAM PLAZA DR SUITE 120
MCMURRAY PA
15317-5412
US

IV. Provider business mailing address

11 KINGS LN
VENETIA PA
15367-1501
US

V. Phone/Fax

Practice location:
  • Phone: 724-941-8877
  • Fax: 724-941-4745
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN216814L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP000695C
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: