1710354071 NPI number — MS. STEPHANIE LYNN LUBIN ROCCA CRNP

Table of content: MS. STEPHANIE LYNN LUBIN ROCCA CRNP (NPI 1710354071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710354071 NPI number — MS. STEPHANIE LYNN LUBIN ROCCA CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUBIN ROCCA
Provider First Name:
STEPHANIE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
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:
ROCCA
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710354071
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2422 WHEATLAND CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELMONT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15626-7203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3436 WILLIAM PENN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15235-5411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-823-6222
Provider Business Practice Location Address Fax Number:
412-823-5392
Provider Enumeration Date:
08/21/2015

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:  SP015248 , 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)

  • Identifier: 1032350120001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".