Healthcare Provider Details

I. General information

NPI: 1780549188
Provider Name (Legal Business Name): AUTUMN M BRINZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 7TH ST STE 201B
NEW KENSINGTON PA
15068-6534
US

IV. Provider business mailing address

251 7TH ST STE 201B
NEW KENSINGTON PA
15068-6534
US

V. Phone/Fax

Practice location:
  • Phone: 724-335-6662
  • Fax: 724-335-3010
Mailing address:
  • Phone: 724-335-6662
  • Fax: 724-335-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP034805
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: