MEDICARE: MISS NICOLE ELAINE FUNT P.A.-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	MA003056L	PA

General Provider Information

NPI Number	:	1073575205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NICOLE ELAINE FUNT P.A.-C

Provider Business Mailing Address
First Line	:	660 WASHINGTON RD
Second Line	:	SUITE 201
City	:	PITTSBURGH
State	:	PA
Zip	:	15228-1915
Country	:	US
Telephone Number	:	412-440-0270
Fax Number	:	412-440-0271

Provider Business Practice Location Address
First Line	:	660 WASHINGTON RD
Second Line	:	SUITE 201
City	:	PITTSBURGH
State	:	PA
Zip	:	15228-1915
Country	:	US
Telephone Number	:	412-440-0270
Fax Number	:	412-440-0271

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	07/08/2007

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