MEDICARE: CONNIE COUSINS CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	113654	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932197977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE COUSINS CRNA

Provider Business Mailing Address
First Line	:	334 FULLINGMILL RD
Second Line	:
City	:	MERCER
State	:	PA
Zip	:	16137-2006
Country	:	US
Telephone Number	:	724-699-5313
Fax Number	:	724-662-9296

Provider Business Practice Location Address
First Line	:	334 FULLINGMILL RD
Second Line	:
City	:	MERCER
State	:	PA
Zip	:	16137-2006
Country	:	US
Telephone Number	:	724-699-5313
Fax Number	:	724-662-9296

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/08/2007

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