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General NPI Number Information
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NPI Number | 1598237216
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Entity Type | Individual
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Provider Name | KEVIN MASON HARRISON CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/19/2018
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 30 MEDICAL CENTER BOULEVARD PROFESSIONAL OFFICE BLDG 1, SUITE 305
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City | UPLAND
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State | PA
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Zip | 19013
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Country | US
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Telephone | 610-874-6448
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Fax |
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Provider Business Mailing Address
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Address Line | 133 MALLARD WAY
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City | MIDDLETOWN
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State | DE
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Zip | 19709-6100
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Country | US
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Telephone | 443-493-3449
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | L6-0A00804
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 125426
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License Number State | PA
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