Provider Demographics
NPI:1700848272
Name:SEMICH, MARY AMBROZIC (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:AMBROZIC
Last Name:SEMICH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BELL COURT RD
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1105
Mailing Address - Country:US
Mailing Address - Phone:412-787-1077
Mailing Address - Fax:
Practice Address - Street 1:100 BELL COURT RD
Practice Address - Street 2:
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-1105
Practice Address - Country:US
Practice Address - Phone:412-787-1077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN204421L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P04291Medicare UPIN
PA036943RUAMedicare PIN