Healthcare Provider Details

I. General information

NPI: 1235668864
Provider Name (Legal Business Name): KAITLYN RISTAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 12/02/2025
Certification Date: 09/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 LUDWICK RD
RUSSELL PA
16345-2125
US

IV. Provider business mailing address

1400 LOCUST ST FL 2
PITTSBURGH PA
15219-5114
US

V. Phone/Fax

Practice location:
  • Phone: 412-335-3533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN600583
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: