Healthcare Provider Details

I. General information

NPI: 1750698130
Provider Name (Legal Business Name): ANTOINETTE THALMAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OXFORD DR SUITE 200
BETHEL PARK PA
15102-1827
US

IV. Provider business mailing address

PO BOX 3445
PITTSBURGH PA
15230-3445
US

V. Phone/Fax

Practice location:
  • Phone: 412-942-2140
  • Fax: 412-942-6027
Mailing address:
  • Phone: 412-937-8887
  • Fax: 412-937-9221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP010938
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberSP010938
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: