Healthcare Provider Details

I. General information

NPI: 1609830967
Provider Name (Legal Business Name): CAROL LOUISE PRIEST MSN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 LEONARD AVE STE 203
WASHINGTON PA
15301-3399
US

IV. Provider business mailing address

95 LEONARD AVE STE 203
WASHINGTON PA
15301-3399
US

V. Phone/Fax

Practice location:
  • Phone: 724-249-2517
  • Fax:
Mailing address:
  • Phone: 724-249-2517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN200888L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberVP005723B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: