Healthcare Provider Details

I. General information

NPI: 1467084368
Provider Name (Legal Business Name): MARIA LYNN KELLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2020
Last Update Date: 02/08/2020
Certification Date: 02/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E NORTH AVE
PITTSBURGH PA
15212-4756
US

IV. Provider business mailing address

201 S MILLVALE AVE APT 1
PITTSBURGH PA
15224-1637
US

V. Phone/Fax

Practice location:
  • Phone: 412-805-6885
  • Fax:
Mailing address:
  • Phone: 412-805-6885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN620655
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: