Basic Information
| Provider Information | |||||||||
| NPI: | 1518006535 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACKIN | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 LOCUST ST | ||||||||
| Address2: | 11500-L, BUILDING B | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152195114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122328939 | ||||||||
| FaxNumber: | 4122328938 | ||||||||
| Practice Location | |||||||||
| Address1: | 565 COAL VALLEY ROAD | ||||||||
| Address2: | ANESTHESIA DEPARTMENT | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122328939 | ||||||||
| FaxNumber: | 4122328938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 077256 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | RN257606L | 01 | PA | REGISTERED NURSE LICENSE | OTHER |