Healthcare Provider Details

I. General information

NPI: 1265143085
Provider Name (Legal Business Name): JONATHAN ANDREW RENT CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 12/13/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE
PITTSBURGH PA
15224-1334
US

IV. Provider business mailing address

1138 ARKANSAS AVE
PITTSBURGH PA
15216-2602
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-5325
  • Fax:
Mailing address:
  • Phone: 412-889-8105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP026737
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: