1396119673 NPI number — SHERI LYNN GONGAWARE-FITZPATRICK CRNP

Table of content: SHERI LYNN GONGAWARE-FITZPATRICK CRNP (NPI 1396119673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396119673 NPI number — SHERI LYNN GONGAWARE-FITZPATRICK CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONGAWARE-FITZPATRICK
Provider First Name:
SHERI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GONGAWARE
Provider Other First Name:
SHERI
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396119673
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
171 SONNIE DR
Provider Second Line Business Mailing Address:
PO BOX 25
Provider Business Mailing Address City Name:
CRABTREE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15624-0025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-558-0592
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 CEDAR RIDGE DR
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15205-9691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-317-0216
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/24/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  SP 015276 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)