Healthcare Provider Details

I. General information

NPI: 1114416070
Provider Name (Legal Business Name): STACEY L NYE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E NORTH AVE
PITTSBURGH PA
15212-4756
US

IV. Provider business mailing address

320 E NORTH AVE
PITTSBURGH PA
15212-4756
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-8820
  • Fax: 412-359-8222
Mailing address:
  • Phone: 412-359-8820
  • Fax: 412-359-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP018796
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: