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General NPI Number Information
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NPI Number | 1538750153
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Entity Type | Individual
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Provider Name | NICOLAS JOHN PERTILE CRNP
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Gender | Male
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Dates
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Enumeration Date | 01/27/2021
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 129 ONEIDA VALLEY RD STE 110
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City | BUTLER
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State | PA
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Zip | 16001-2252
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Country | US
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Telephone | 724-431-2912
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Fax |
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Provider Business Mailing Address
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Address Line | 1409 CHAPLIN ST
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City | CONWAY
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State | PA
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Zip | 15027-1121
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Country | US
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Telephone | 724-714-4711
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP022588
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License Number State | PA
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