Healthcare Provider Details

I. General information

NPI: 1306570163
Provider Name (Legal Business Name): DAMIAN ROMAN CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 02/03/2023
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 39TH ST APT 424
PITTSBURGH PA
15201-3304
US

IV. Provider business mailing address

147 39TH ST # C424
PITTSBURGH PA
15201-3237
US

V. Phone/Fax

Practice location:
  • Phone: 206-713-6919
  • Fax:
Mailing address:
  • Phone: 206-713-6919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN749927
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP027055
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: