=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174357487
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIKAYLA MARIE PANCHAL FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2024
-----------------------------------------------------
Last Update Date | 09/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2201 PARK MANOR BLVD
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15205-4819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-773-8950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4029 WINDSFIELD WAY
-----------------------------------------------------
City | BRIDGEVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15017-3117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-627-3155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | SP032288
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------