Provider Demographics
NPI:1417926049
Name:MARREN, KEVIN M (CRNP, MSN)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:M
Last Name:MARREN
Suffix:
Gender:M
Credentials:CRNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 CENTER AVENUE
Mailing Address - Street 2:SUITE 715
Mailing Address - City:PGH.
Mailing Address - State:PA
Mailing Address - Zip Code:15232
Mailing Address - Country:US
Mailing Address - Phone:412-623-5379
Mailing Address - Fax:412-623-3143
Practice Address - Street 1:5200 CENTER AVENUE
Practice Address - Street 2:SUITE 715
Practice Address - City:PGH.
Practice Address - State:PA
Practice Address - Zip Code:15232
Practice Address - Country:US
Practice Address - Phone:412-623-5379
Practice Address - Fax:412-623-3143
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008721363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ59506Medicare UPIN
PA600678JULMedicare ID - Type UnspecifiedGROUP
PA096834JULMedicare ID - Type UnspecifiedINDIVIDUAL