Provider Demographics
NPI:1104073006
Name:DEIBERT, AMY MARIE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:DEIBERT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:FEDEROFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2 HOT METAL ST
Mailing Address - Street 2:QUANTUM ONE, N467
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2348
Mailing Address - Country:US
Mailing Address - Phone:412-432-5806
Mailing Address - Fax:412-432-7691
Practice Address - Street 1:5115 CENTRE AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1301
Practice Address - Country:US
Practice Address - Phone:412-235-1020
Practice Address - Fax:412-235-1030
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009914363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA197542Medicare PIN