Healthcare Provider Details

I. General information

NPI: 1932197977
Provider Name (Legal Business Name): CONNIE COUSINS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 FULLINGMILL RD
MERCER PA
16137-2006
US

IV. Provider business mailing address

334 FULLINGMILL RD
MERCER PA
16137-2006
US

V. Phone/Fax

Practice location:
  • Phone: 724-699-5313
  • Fax: 724-662-9296
Mailing address:
  • Phone: 724-699-5313
  • Fax: 724-662-9296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number113654
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: