Healthcare Provider Details

I. General information

NPI: 1316293012
Provider Name (Legal Business Name): SUSAN STREET CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 MONROEVILLE BLVD
MONROEVILLE PA
15146
US

IV. Provider business mailing address

200 LOTHROP ST FORBES TOWER, SUITE 9055
PITTSBURGH PA
15213-2536
US

V. Phone/Fax

Practice location:
  • Phone: 412-357-3000
  • Fax:
Mailing address:
  • Phone: 412-647-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP012156
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP012156
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: