Healthcare Provider Details

I. General information

NPI: 1376756387
Provider Name (Legal Business Name): TESSIE B. TRUSKOWSKI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 1ST ST
FREEDOM PA
15042-2464
US

IV. Provider business mailing address

113 HILLTOP CT
BADEN PA
15005-2417
US

V. Phone/Fax

Practice location:
  • Phone: 724-266-2833
  • Fax: 724-869-5321
Mailing address:
  • Phone: 724-869-5937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberVP003905B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: