Healthcare Provider Details

I. General information

NPI: 1528519428
Provider Name (Legal Business Name): KAREN L CASSELBURY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN FREY

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 09/04/2022
Certification Date: 09/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUTHRIE SQ
SAYRE PA
18840
US

IV. Provider business mailing address

1 GUTHRIE SQ
SAYRE PA
18840-1625
US

V. Phone/Fax

Practice location:
  • Phone: 570-887-5583
  • Fax: 570-887-4464
Mailing address:
  • Phone: 570-888-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN323235L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: