Healthcare Provider Details

I. General information

NPI: 1952302218
Provider Name (Legal Business Name): KATHLEEN CARPEN BORDICK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 JOHNSONBURG RD ERPG ANESTHESIA SERVICES
SAINT MARYS PA
15857-3417
US

IV. Provider business mailing address

763 JOHNSONBURG RD ERPG ANESTHESIA SERVICES
SAINT MARYS PA
15857-3417
US

V. Phone/Fax

Practice location:
  • Phone: 814-788-8562
  • Fax: 814-788-8387
Mailing address:
  • Phone: 814-788-8562
  • Fax: 814-788-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN244084L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: