Healthcare Provider Details

I. General information

NPI: 1154321511
Provider Name (Legal Business Name): NICHOLAS KACHUR CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 GALLAGHER DR
PLAINS PA
18705-1146
US

IV. Provider business mailing address

11 GALLAGHER DR
PLAINS PA
18705-1146
US

V. Phone/Fax

Practice location:
  • Phone: 570-970-1030
  • Fax: 570-270-0577
Mailing address:
  • Phone: 570-970-1030
  • Fax: 570-270-0577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number016467
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: