1750547253 NPI number — MARIE C. ENGBERG CRNP

Table of content: MARIE C. ENGBERG CRNP (NPI 1750547253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750547253 NPI number — MARIE C. ENGBERG CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENGBERG
Provider First Name:
MARIE
Provider Middle Name:
C.
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:
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:
1750547253
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901-B WEST STREET
Provider Second Line Business Mailing Address:
METRO FAMILY PRACTICE, INC.
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-247-2310
Provider Business Mailing Address Fax Number:
412-247-2373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901-B WEST STREET
Provider Second Line Business Practice Location Address:
METRO FAMILY PRACTICE, INC.
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-247-2310
Provider Business Practice Location Address Fax Number:
412-247-2373
Provider Enumeration Date:
08/04/2008

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:  SP009889 , 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: SP009889 . This is a "LICENSE NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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