Basic Information
Provider Information
NPI: 1295721579
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FERENCE
FirstName: AMY
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1699 WASHINGTON RD
Address2: SUITE 400
City: PITTSBURGH
State: PA
PostalCode: 152281629
CountryCode: US
TelephoneNumber: 4128511820
FaxNumber: 4128511822
Practice Location
Address1: 565 COAL VALLEY RD
Address2:  
City: PITTSBURGH
State: PA
PostalCode: 15236
CountryCode: US
TelephoneNumber: 4128511820
FaxNumber: 4128511822
Other Information
ProviderEnumerationDate: 09/22/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X051882PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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