Basic Information
| Provider Information | |||||||||
| NPI: | 1659373082 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PFEIFFER | ||||||||
| FirstName: | RENEE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 490 E NORTH AVE STE 500 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152124765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123598860 | ||||||||
| FaxNumber: | 4123598809 | ||||||||
| Practice Location | |||||||||
| Address1: | 490 E NORTH AVE STE 500 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152124765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123598860 | ||||||||
| FaxNumber: | 4123598809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 10/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | TP003262M | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 103363907 | 05 | PA | MEDICAID | 11683937 | 01 | CAQH | OTHER |