Healthcare Provider Details

I. General information

NPI: 1396268884
Provider Name (Legal Business Name): JENNA AILEEN ZIDANSEK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 07/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 CENTER AVE
PITTSBURGH PA
15229-1724
US

IV. Provider business mailing address

210 19TH ST
PITTSBURGH PA
15215-2703
US

V. Phone/Fax

Practice location:
  • Phone: 412-931-3066
  • Fax: 412-931-2464
Mailing address:
  • Phone: 724-866-4627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP017617
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: