Healthcare Provider Details

I. General information

NPI: 1295545341
Provider Name (Legal Business Name): BETHANY BLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 WASHINGTON RD STE 811
PITTSBURGH PA
15241-2513
US

IV. Provider business mailing address

811 RED BARN CT
BETHEL PARK PA
15102-3257
US

V. Phone/Fax

Practice location:
  • Phone: 412-238-2800
  • Fax:
Mailing address:
  • Phone: 412-736-4539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN618997
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP019589
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: