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NPI Code Detail

MEDICARE: RAVEN PONTON CRNP

MEDICARE: RAVEN PONTON CRNP
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
1363LF0000XFamily Nurse PractitionerSP030633PA

General Provider Information

NPI Number : 1093521544
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAVEN PONTON CRNP
Provider Business Mailing Address
First Line : 4 ALLEGHENY CTR FL 7
Second Line :
City : PITTSBURGH
State : PA
Zip : 15212-5227
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5426 MIFFLIN RD
Second Line :
City : PITTSBURGH
State : PA
Zip : 15207-2350
Country : US
Telephone Number : 412-462-1800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2024
Last Update Date : 01/07/2026

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Directions to “ RAVEN PONTON CRNP” Practice Location

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