MEDICARE: DEBRA K CORREA 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
1	363L00000X	Nurse Practitioner	SP003754B	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11676854	OTHER	PA	CAQH

General Provider Information

NPI Number	:	1093786006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA K CORREA CRNP

Provider Business Mailing Address
First Line	:	2 HOT METAL ST
Second Line	:	QUANTUM ONE, N431
City	:	PITTSBURGH
State	:	PA
Zip	:	15203-2348
Country	:	US
Telephone Number	:	412-432-5806
Fax Number	:	412-432-7691

Provider Business Practice Location Address
First Line	:	1800 PINE HOLLOW RD
Second Line	:	SUITE 1A
City	:	MC KEES ROCKS
State	:	PA
Zip	:	15136-1516
Country	:	US
Telephone Number	:	412-771-9561
Fax Number	:	412-771-5296

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

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	04/03/2009

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