Healthcare Provider Details

I. General information

NPI: 1619940335
Provider Name (Legal Business Name): AMY LYNN HERRMANN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 CENTRE AVE
PITTSBURGH PA
15232-1304
US

IV. Provider business mailing address

5230 CENTRE AVE
PITTSBURGH PA
15232-1304
US

V. Phone/Fax

Practice location:
  • Phone: 412-623-2167
  • Fax:
Mailing address:
  • Phone: 412-623-2167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN512045L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: