Healthcare Provider Details

I. General information

NPI: 1083089783
Provider Name (Legal Business Name): AMBER MARIE GRINNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 ANDERSON ST
PITTSBURGH PA
15212-5803
US

IV. Provider business mailing address

844 N SHERIDAN AVE
PITTSBURGH PA
15206-2286
US

V. Phone/Fax

Practice location:
  • Phone: 412-322-4151
  • Fax:
Mailing address:
  • Phone: 412-849-4450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015650
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: