Healthcare Provider Details

I. General information

NPI: 1437537958
Provider Name (Legal Business Name): KATELYN JANE LASEK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN JANE SHANE CRNP

II. Dates (important events)

Enumeration Date: 05/16/2015
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 FRIENDSHIP AVE
PITTSBURGH PA
15224-1722
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 412-578-5858
  • Fax: 412-578-1529
Mailing address:
  • Phone: 330-729-7633
  • Fax: 330-729-7656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberSP012525
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: