MEDICARE: WENDY FUSAN 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	TP006806B	PA

General Provider Information

NPI Number	:	1891980199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY FUSAN CRNP

Provider Business Mailing Address
First Line	:	200 DELAFIELD RD STE 1040
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15215-3234
Country	:	US
Telephone Number	:	412-782-3990
Fax Number	:	412-782-3993

Provider Business Practice Location Address
First Line	:	200 DELAFIELD RD STE 1040
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15215-3234
Country	:	US
Telephone Number	:	412-782-3990
Fax Number	:	412-782-3993

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

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	09/10/2007

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