Provider Demographics
NPI:1720051915
Name:SEDLACKO, LAUREL G (CRNA)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:G
Last Name:SEDLACKO
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 1:150 CRISSINGER RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6455
Mailing Address - Country:US
Mailing Address - Phone:724-834-7794
Mailing Address - Fax:
Practice Address - Street 1:150 CRISSINGER RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6455
Practice Address - Country:US
Practice Address - Phone:724-834-7794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA045051367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASE743191OtherBLUE SHIELD