MEDICARE: MRS. TIFFANY D. PELLATHY CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	AC000410	MD
2	363AM0700X	Medical Physician Assistant	AC000410	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558436774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIFFANY D. PELLATHY CRNP

Provider Business Mailing Address
First Line	:	3000 VILLAGE RUN RD
Second Line	:	BLDG. 103-202
City	:	WEXFORD
State	:	PA
Zip	:	15090-6315
Country	:	US
Telephone Number	:	412-867-9585
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 VILLAGE RUN RD
Second Line	:	BLDG. 103-202
City	:	WEXFORD
State	:	PA
Zip	:	15090-6315
Country	:	US
Telephone Number	:	412-867-9585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	01/31/2011

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