MEDICARE: KATHLEEN CARPEN BORDICK 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	RN244084L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN244084L	OTHER	PA	RN LICENSE

General Provider Information

NPI Number	:	1952302218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN CARPEN BORDICK CRNA

Provider Business Mailing Address
First Line	:	763 JOHNSONBURG RD
Second Line	:	ERPG ANESTHESIA SERVICES
City	:	SAINT MARYS
State	:	PA
Zip	:	15857-3417
Country	:	US
Telephone Number	:	814-788-8562
Fax Number	:	814-788-8387

Provider Business Practice Location Address
First Line	:	763 JOHNSONBURG RD
Second Line	:	ERPG ANESTHESIA SERVICES
City	:	SAINT MARYS
State	:	PA
Zip	:	15857-3417
Country	:	US
Telephone Number	:	814-788-8562
Fax Number	:	814-788-8387

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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