Provider Demographics
NPI:1891427118
Name:MACFAWN, LAURYN GRACE (CRNA)
Entity Type:Individual
Prefix:
First Name:LAURYN
Middle Name:GRACE
Last Name:MACFAWN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LAURYN
Other - Middle Name:GRACE
Other - Last Name:RUCKERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:401 AMBERSON AVE APT 137
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1456
Mailing Address - Country:US
Mailing Address - Phone:240-362-3254
Mailing Address - Fax:
Practice Address - Street 1:200 LOTHROP ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2536
Practice Address - Country:US
Practice Address - Phone:240-362-3254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN770389367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered