Healthcare Provider Details

I. General information

NPI: 1073054904
Provider Name (Legal Business Name): LAURA KAWALICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2017
Last Update Date: 06/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 LOCUST ST
PITTSBURGH PA
15219-5114
US

IV. Provider business mailing address

6 QUAIL HILL RD
OBSERVATORY PA
15214-1442
US

V. Phone/Fax

Practice location:
  • Phone: 412-232-8939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number116082
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: