Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 367500000X | Nurse Anesthetist, Certified Registered | | RN153354L | PENNSYLVANIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 808862 | OTHER | PENNSYLVANIA | BLUE SHIELD BLK 33 GRP |
| 2 | 064245LCU | MEDICARE PIN | PENNSYLVANIA | |
| 3 | DD4802 | OTHER | PENNSYLVANIA | PALMETTO GBA BLK 33 GRP |
| 4 | 050555457 | OTHER | PENNSYLVANIA | UPMC BLK 33 GRP |
| 5 | 072952 | OTHER | PENNSYLVANIA | BLUE SHIELD BLK 33 PIN |
| 6 | 0019613040001 | MEDICAID | PENNSYLVANIA | |
| 7 | P00230587 | OTHER | PENNSYLVANIA | PALMETTO GBA BLK 33 PIN |
| 8 | 050555457 | OTHER | PENNSYLVANIA | COMMERCIAL BLK 33 GRP |
| 9 | R88943 | OTHER | PENNSYLVANIA | COMMERCIAL BLK 33 PIN |
| 10 | 312161 | OTHER | PENNSYLVANIA | UPMC BLK 33 PIN |
| 11 | 0019607640001 | MEDICAID | PENNSYLVANIA | |
| 12 | R88943 | MEDICARE UPIN | PENNSYLVANIA | |
| 13 | 064245R2M | MEDICARE PIN | PENNSYLVANIA | |
| 14 | 1520056 | OTHER | PENNSYLVANIA | BLUE SHIELD BLK 33 GRP |
| 15 | 994588 | OTHER | PENNSYLVANIA | BLUE SHIELD BLK 33 PIN |
