Healthcare Provider Details

I. General information

NPI: 1689808495
Provider Name (Legal Business Name): ROBERT JUDE WIRTH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 FORBES AVE
PITTSBURGH PA
15213-3317
US

IV. Provider business mailing address

3501 FORBES AVE
PITTSBURGH PA
15213-3317
US

V. Phone/Fax

Practice location:
  • Phone: 412-266-5882
  • Fax: 412-246-5640
Mailing address:
  • Phone: 412-266-5882
  • Fax: 412-246-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN279252L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: