Healthcare Provider Details

I. General information

NPI: 1174243257
Provider Name (Legal Business Name): HAYDEE BAEZA FEWELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 ALLEQUIPPA ST
PITTSBURGH PA
15240
US

IV. Provider business mailing address

115 PALOMINO CT
CANONSBURG PA
15317-2773
US

V. Phone/Fax

Practice location:
  • Phone: 412-822-2222
  • Fax:
Mailing address:
  • Phone: 913-704-8765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN742399
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: