Basic Information
| Provider Information | |||||||||
| NPI: | 1134752488 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANNI | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | BETH | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 BOWER HILL ROAD | ||||||||
| Address2: | ATTN: AFFILIATE BILLING PAMALYN | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152431873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129422548 | ||||||||
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| Practice Location | |||||||||
| Address1: | 188 EDGEWOOD ST | ||||||||
| Address2: | |||||||||
| City: | ALIQUIPPA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150011814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249140283 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2020 | ||||||||
| LastUpdateDate: | 09/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP021449 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.