Provider Demographics
NPI:1396268884
Name:ZIDANSEK, JENNA AILEEN (CRNP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:AILEEN
Last Name:ZIDANSEK
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 1:210 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15215-2703
Mailing Address - Country:US
Mailing Address - Phone:724-866-4627
Mailing Address - Fax:
Practice Address - Street 1:1020 CENTER AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15229-1724
Practice Address - Country:US
Practice Address - Phone:412-931-3066
Practice Address - Fax:412-931-2464
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017617363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily