MEDICARE: GRETCHEN RENEE HERDA 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	SP007978	PA
2	363L00000X	Nurse Practitioner	286802	MT

General Provider Information

NPI Number	:	1487650529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN RENEE HERDA CRNP

Provider Business Mailing Address
First Line	:	200 LOTHROP ST
Second Line	:	FORBES TOWER SUITE 10055B
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-2536
Country	:	US
Telephone Number	:	412-864-0594
Fax Number	:	412-647-3222

Provider Business Practice Location Address
First Line	:	200 LOTHROP ST
Second Line	:	FORBES TOWER SUITE 10055B
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-2536
Country	:	US
Telephone Number	:	412-864-0594
Fax Number	:	412-647-3222

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	03/17/2026

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