Provider Demographics
NPI:1538036926
Name:DEGRUTTOLA, AVERY
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:DEGRUTTOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 REGINA DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037-1036
Mailing Address - Country:US
Mailing Address - Phone:412-860-5079
Mailing Address - Fax:
Practice Address - Street 1:2626 HAYMAKER RD FL 2
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3516
Practice Address - Country:US
Practice Address - Phone:412-373-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-20
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP034216363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner