Healthcare Provider Details

I. General information

NPI: 1770374670
Provider Name (Legal Business Name): LAVAL R KREPP CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2566 HAYMAKER RD STE 304
MONROEVILLE PA
15146-3555
US

IV. Provider business mailing address

2566 HAYMAKER RD STE 304
MONROEVILLE PA
15146-3555
US

V. Phone/Fax

Practice location:
  • Phone: 412-858-3070
  • Fax:
Mailing address:
  • Phone: 412-858-3070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP032074
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP032074
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP032074
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: