Provider Demographics
NPI:1194769422
Name:BETTUA, GRETCHEN L (CRNP)
Entity type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:L
Last Name:BETTUA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:GRETCHEN
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:960 PENN AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-3818
Mailing Address - Country:US
Mailing Address - Phone:724-658-6681
Mailing Address - Fax:724-658-6883
Practice Address - Street 1:960 PENN AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-3818
Practice Address - Country:US
Practice Address - Phone:724-658-6681
Practice Address - Fax:724-658-6883
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP04998363L00000X
PAUP005140B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2655345Medicaid
OH000000529807OtherANTHEM
OH753010OtherBUCKEYE
OH2655345Medicaid
OHP00403336Medicare PIN
OH000000529807OtherANTHEM