MEDICARE: MRS. JOANNA ROBERTA MCNALLY 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	163W00000X	Registered Nurse	RN518829L	PA
2	363L00000X	Nurse Practitioner	SP008329	PA

General Provider Information

NPI Number	:	1255391264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOANNA ROBERTA MCNALLY CRNP

Provider Business Mailing Address
First Line	:	1630 ARLINGTON AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15210-1737
Country	:	US
Telephone Number	:	412-641-1230
Fax Number	:	412-488-3890

Provider Business Practice Location Address
First Line	:	1630 ARLINGTON AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15210-1737
Country	:	US
Telephone Number	:	412-641-1230
Fax Number	:	412-488-3890

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	04/13/2017

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