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General NPI Number Information
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NPI Number | 1770469587
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Entity Type | Organization
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Legal Business Name | GREAT LAKES ANESTHETISTS
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 5515 PEACH ST
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City | ERIE
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State | PA
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Zip | 16509-2603
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Country | US
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Telephone | 814-864-4031
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 108
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City | HOLLIDAYSBURG
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State | PA
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Zip | 16648-0108
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Country | US
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Telephone | 814-696-8886
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SEAN NUTTER
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Credential | CRNA
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Telephone | 814-460-7646
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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 |
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License Number State |
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