Healthcare Provider Details

I. General information

NPI: 1730580762
Provider Name (Legal Business Name): YOVANA BONTRAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE
PITTSBURGH PA
15224-1334
US

IV. Provider business mailing address

4401 PENN AVE
PITTSBURGH PA
15224-1334
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-7280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA060620
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: