Provider Demographics
NPI:1588290407
Name:IDLEBURG-PATTY, MICHAELA (MS, CGC)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:IDLEBURG-PATTY
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:
Other - Last Name:IDLEBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:4401 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1334
Mailing Address - Country:US
Mailing Address - Phone:412-692-7612
Mailing Address - Fax:
Practice Address - Street 1:4401 PENN AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1334
Practice Address - Country:US
Practice Address - Phone:412-692-7612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAGC000588170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS