Provider Demographics
NPI:1386093250
Name:LAW, PHYLLIS TERESE (CRNP)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:TERESE
Last Name:LAW
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BROOKS LN
Mailing Address - Street 2:SUITE 180
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3747
Mailing Address - Country:US
Mailing Address - Phone:412-469-3600
Mailing Address - Fax:412-469-3630
Practice Address - Street 1:1200 BROOKS LN
Practice Address - Street 2:SUITE 180
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3747
Practice Address - Country:US
Practice Address - Phone:412-469-3600
Practice Address - Fax:412-469-3630
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP016125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily