Provider Demographics
NPI:1528096427
Name:DESANTIS, AMERICUS J (CRNP)
Entity type:Individual
Prefix:MR
First Name:AMERICUS
Middle Name:J
Last Name:DESANTIS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 VOLLMER DR
Mailing Address - Street 2:
Mailing Address - City:GLENSHAW
Mailing Address - State:PA
Mailing Address - Zip Code:15116-2160
Mailing Address - Country:US
Mailing Address - Phone:412-487-2720
Mailing Address - Fax:412-692-4223
Practice Address - Street 1:1831 VOLLMER DR
Practice Address - Street 2:
Practice Address - City:GLENSHAW
Practice Address - State:PA
Practice Address - Zip Code:15116-2160
Practice Address - Country:US
Practice Address - Phone:412-487-2720
Practice Address - Fax:412-692-4223
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP002288C363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
064547K8BMedicare ID - Type Unspecified
P72975Medicare UPIN