Provider Demographics
NPI:1851118418
Name:FITZGERALD, DEAINNA (MT)
Entity type:Individual
Prefix:
First Name:DEAINNA
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 N JOSLYN DR
Mailing Address - Street 2:
Mailing Address - City:PENN HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15235-3928
Mailing Address - Country:US
Mailing Address - Phone:412-953-0991
Mailing Address - Fax:
Practice Address - Street 1:2924 MCKELVEY RD STE 4
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-4512
Practice Address - Country:US
Practice Address - Phone:412-953-0991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN729302163WG0000X
374J00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No374J00000XNursing Service Related ProvidersDoula