Healthcare Provider Details

I. General information

NPI: 1518204544
Provider Name (Legal Business Name): AMANDA LYNN DRUSAK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 REDSTONE CHURCH RD
PERRYOPOLIS PA
15473-1286
US

IV. Provider business mailing address

550 REDSTONE CHURCH RD
PERRYOPOLIS PA
15473-1286
US

V. Phone/Fax

Practice location:
  • Phone: 724-322-0581
  • Fax:
Mailing address:
  • Phone: 724-322-0581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN583986
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: