Healthcare Provider Details

I. General information

NPI: 1992200745
Provider Name (Legal Business Name): MARY RUTH ZILAITIS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N LEWIS RUN RD
WEST MIFFLIN PA
15122-3056
US

IV. Provider business mailing address

12 BARRINGTON DR
PITTSBURGH PA
15209-1721
US

V. Phone/Fax

Practice location:
  • Phone: 412-651-1711
  • Fax:
Mailing address:
  • Phone: 412-519-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP018686
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: