Healthcare Provider Details

I. General information

NPI: 1477554087
Provider Name (Legal Business Name): CHARLES DEAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W BERKELEY ST
UNIONTOWN PA
15401-5514
US

IV. Provider business mailing address

PO BOX 1032
UNIONTOWN PA
15401-1032
US

V. Phone/Fax

Practice location:
  • Phone: 724-437-6730
  • Fax:
Mailing address:
  • Phone: 201-804-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN181488L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: