Basic Information
| Provider Information | |||||||||
| NPI: | 1326678582 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NESTOR | ||||||||
| FirstName: | JERROD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 226 | ||||||||
| Address2: | |||||||||
| City: | MUSE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153500226 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 REEDSDALE ST | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152332109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776372924 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2020 | ||||||||
| LastUpdateDate: | 02/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | RN663829 | PA | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | SP021424 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.