Provider Demographics
NPI:1932174646
Name:OSTLUND, SORENA ANN (CRNA)
Entity Type:Individual
Prefix:PROF
First Name:SORENA
Middle Name:ANN
Last Name:OSTLUND
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 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-1363
Mailing Address - Country:US
Mailing Address - Phone:814-849-2312
Mailing Address - Fax:814-849-4841
Practice Address - Street 1:100 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825
Practice Address - Country:US
Practice Address - Phone:814-849-2312
Practice Address - Fax:814-849-4841
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN259047L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001582680Medicaid
PAR86066Medicare UPIN