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General NPI Number Information
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NPI Number | 1821190240
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Entity Type | Individual
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Provider Name | LAURA LEE KUSTABORDER PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 04/03/2013
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Provider Practice Location Address
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Address Line | 5115 CENTRE AVE HILLMAN CANCER CENTER, 2ND FLOOR
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City | PITTSBURGH
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State | PA
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Zip | 15232-1301
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Country | US
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Telephone | 412-864-7930
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Fax | 412-623-2540
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Provider Business Mailing Address
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Address Line | 119 OCALA TRAIL DR
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City | PITTSBURGH
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State | PA
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Zip | 15235-3531
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Country | US
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Telephone | 412-874-7129
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA054247
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License Number State | PA
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