Healthcare Provider Details

I. General information

NPI: 1659707917
Provider Name (Legal Business Name): KASEY ROYCE MAHOLAGE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE CHILDREN'S HOSPITAL DRIVE 4401 PENN AVENUE
PITTSBURGH PA
15224-1334
US

IV. Provider business mailing address

2570 HAYMAKER RD
MONROEVILLE PA
15146
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-5260
  • Fax: 412-692-8658
Mailing address:
  • Phone: 412-858-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN582620
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: