Provider Demographics
NPI:1568000792
Name:HORNE, DYLAN C (CRNA)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:C
Last Name:HORNE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 CENTRE AVE APT 30
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1739
Mailing Address - Country:US
Mailing Address - Phone:814-341-0735
Mailing Address - Fax:
Practice Address - Street 1:4750 CENTRE AVE APT 30
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1739
Practice Address - Country:US
Practice Address - Phone:814-341-0735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN672576163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103856276Medicaid
PA1M8392OtherMEDICARE