1629460050 NPI number — MRS. JENNA DANIELLE FEDEROFF CRNP

Table of content: MRS. JENNA DANIELLE FEDEROFF CRNP (NPI 1629460050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629460050 NPI number — MRS. JENNA DANIELLE FEDEROFF CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEDEROFF
Provider First Name:
JENNA
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
MRS.
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629460050
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 SCOTTDALE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15205-9421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-974-8802
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 E NORTH AVE
Provider Second Line Business Practice Location Address:
#205
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15212-4746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-359-3426
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2015

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:  SP014795 , 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)





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