Healthcare Provider Details

I. General information

NPI: 1336072248
Provider Name (Legal Business Name): MARISA MATTIOLI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 DELAFIELD RD
PITTSBURGH PA
15215-3205
US

IV. Provider business mailing address

111 HIGH POINT RD
SARVER PA
16055-9481
US

V. Phone/Fax

Practice location:
  • Phone: 412-781-4860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP035986
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: