Healthcare Provider Details

I. General information

NPI: 1104073006
Provider Name (Legal Business Name): AMY MARIE DEIBERT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY MARIE FEDEROFF CRNP

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 CENTRE AVE 3RD FLOOR
PITTSBURGH PA
15232-1301
US

IV. Provider business mailing address

2 HOT METAL ST QUANTUM ONE, N467
PITTSBURGH PA
15203-2348
US

V. Phone/Fax

Practice location:
  • Phone: 412-235-1020
  • Fax: 412-235-1030
Mailing address:
  • Phone: 412-432-5806
  • Fax: 412-432-7691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP009914
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: