Healthcare Provider Details

I. General information

NPI: 1871078840
Provider Name (Legal Business Name): JANE PITZULO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 E STATE ST
SALEM OH
44460-2423
US

IV. Provider business mailing address

8059 FOREST LAKE DR
BOARDMAN OH
44512-5912
US

V. Phone/Fax

Practice location:
  • Phone: 330-332-7214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number50.005637RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.005637RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: