Healthcare Provider Details

I. General information

NPI: 1770128654
Provider Name (Legal Business Name): ALEXIS KAROLAK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ROBINSON PLZ STE 340
PITTSBURGH PA
15205-1018
US

IV. Provider business mailing address

117 VIP DR STE 310
WEXFORD PA
15090-6936
US

V. Phone/Fax

Practice location:
  • Phone: 724-934-3905
  • Fax: 724-934-3906
Mailing address:
  • Phone: 724-934-3905
  • Fax: 724-934-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberSP021093
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP021093
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: