Healthcare Provider Details

I. General information

NPI: 1710415443
Provider Name (Legal Business Name): ALISSA ANN FRANKLIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISA ANN MURRAY REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 05/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E PARK AVE
STATE COLLEGE PA
16803-6709
US

IV. Provider business mailing address

14A N BROWN ST
LEWISTOWN PA
17044-1733
US

V. Phone/Fax

Practice location:
  • Phone: 717-437-1040
  • Fax:
Mailing address:
  • Phone: 717-437-1040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number116808
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: