MEDICARE: LISAMARIE PIETRAGALLO NP-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	363LF0000X	Family Nurse Practitioner	COA.-16648-NP	OH
2	363LP2300X	Primary Care Nurse Practitioner	16648-NP	OH

General Provider Information

NPI Number	:	1376946319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISAMARIE PIETRAGALLO NP-C

Provider Business Mailing Address
First Line	:	9375 E MARKET ST
Second Line	:	SUITE 1
City	:	WARREN
State	:	OH
Zip	:	44484-5552
Country	:	US
Telephone Number	:	330-609-5089
Fax Number	:

Provider Business Practice Location Address
First Line	:	9375 E MARKET ST
Second Line	:	SUITE 1
City	:	WARREN
State	:	OH
Zip	:	44484-5552
Country	:	US
Telephone Number	:	330-609-5089
Fax Number	:

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

Provider Enumeration Date	:	10/06/2014
Last Update Date	:	07/06/2016

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