Healthcare Provider Details

I. General information

NPI: 1518302256
Provider Name (Legal Business Name): MICHELENE YASMIN JETER OGAGAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELENE YASMIN JETER

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LOTHROP ST SUITE 200 C-WING
PITTSBURGH PA
15213-2536
US

IV. Provider business mailing address

200 LOTHROP ST SUITE 9055 FORBES TOWER
PITTSBURGH PA
15213-2536
US

V. Phone/Fax

Practice location:
  • Phone: 412-647-5909
  • Fax: 412-647-0342
Mailing address:
  • Phone: 412-647-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN601250
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: