Provider Demographics
NPI:1609830967
Name:PRIEST, CAROL LOUISE (MSN CRNP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LOUISE
Last Name:PRIEST
Suffix:
Gender:F
Credentials:MSN CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 LEONARD AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3399
Mailing Address - Country:US
Mailing Address - Phone:724-249-2517
Mailing Address - Fax:
Practice Address - Street 1:95 LEONARD AVE STE 203
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3399
Practice Address - Country:US
Practice Address - Phone:724-249-2517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN200888L163W00000X
PAVP005723B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPR770760OtherHIGHMARK
PAPR770760OtherHIGHMARK
Q16693Medicare UPIN
PA079560L5TMedicare PIN
PA079560PAZMedicare PIN