Basic Information
Provider Information
NPI: 1205442878
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SZYMANSKI
FirstName: HALLIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 320 E NORTH AVE
Address2:  
City: PITTSBURGH
State: PA
PostalCode: 152124756
CountryCode: US
TelephoneNumber: 4123598820
FaxNumber:  
Practice Location
Address1: 320 E NORTH AVE
Address2:  
City: PITTSBURGH
State: PA
PostalCode: 152124756
CountryCode: US
TelephoneNumber: 4123598820
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/19/2020
LastUpdateDate: 11/09/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/09/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XSP022539PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
1542215901 CAQHOTHER


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