Provider Demographics
NPI:1194962647
Name:KOEHLER, MARK P (CRNA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:P
Last Name:KOEHLER
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 1:4485 WILLIAM FLYNN HWY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-1424
Mailing Address - Country:US
Mailing Address - Phone:412-492-0800
Mailing Address - Fax:412-492-4057
Practice Address - Street 1:4485 WILLIAM FLYNN HWY
Practice Address - Street 2:SUITE 3
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-1424
Practice Address - Country:US
Practice Address - Phone:412-492-0800
Practice Address - Fax:412-492-4057
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN354911L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered