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General NPI Number Information
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NPI Number | 1114143583
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Entity Type | Individual
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Provider Name | KAREN MARIE KAVANAGH CRNP
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Gender | Female
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 06/04/2008
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Provider Practice Location Address
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Address Line | 20397 ROUTE 19 TWO LANDMARK NORTH SUITE 220
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City | CRANBERRY TWP
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State | PA
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Zip | 16066
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Country | US
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Telephone | 724-772-5430
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Fax | 724-772-5431
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Provider Business Mailing Address
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Address Line | 20397 ROUTE 19 TWO LANDMARK NORTH SUITE 220
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City | CRANBERRY TWP
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State | PA
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Zip | 16066
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Country | US
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Telephone | 724-772-5430
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Fax | 724-772-5431
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | VP005694D
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License Number State | PA
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