Healthcare Provider Details

I. General information

NPI: 1982396149
Provider Name (Legal Business Name): LIJIA LU CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HOSPITAL WAY PAINTER BUILDING, SUITE 401
MCKEESPORT PA
15132-2422
US

IV. Provider business mailing address

3601 5TH AVE STE 3B
PITTSBURGH PA
15213-3403
US

V. Phone/Fax

Practice location:
  • Phone: 412-672-5766
  • Fax:
Mailing address:
  • Phone: 412-586-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberSP025949
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP025949
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: