Healthcare Provider Details

I. General information

NPI: 1073576971
Provider Name (Legal Business Name): GRETCHEN L. TUNSTALL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LOTHROP ST UPP
PITTSBURGH PA
15213
US

IV. Provider business mailing address

5 TARA DR
PITTSBURGH PA
15209-1059
US

V. Phone/Fax

Practice location:
  • Phone: 412-647-8762
  • Fax:
Mailing address:
  • Phone: 412-486-2380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN323659L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: