Individual
ERIC DIVELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
201 STATE ST, ERIE, PA 16550-0002
(814) 877-2621
(814) 877-7049
Mailing address
4606 WOLF RD, ERIE, PA 16505-1451
(814) 449-5752
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
695200-1
NY
163W00000X
Registered Nurse
RN641349
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN641349
PA
Other
Enumeration date
04/26/2017
Last updated
06/10/2019
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