Healthcare Provider Details

I. General information

NPI: 1891608519
Provider Name (Legal Business Name): AMY DIANE JAGEMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 LOCUST ST
PITTSBURGH PA
15219-5114
US

IV. Provider business mailing address

1423 HASTINGS CRES
BRIDGEVILLE PA
15017-3110
US

V. Phone/Fax

Practice location:
  • Phone: 412-232-8111
  • Fax:
Mailing address:
  • Phone: 412-477-1072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number160997
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: