Provider Demographics
NPI:1043470198
Name:BLINN, BETH RENEE (CRNP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:RENEE
Last Name:BLINN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:RENEE
Other - Last Name:MCDEAVITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2585 FREEPORT ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-1426
Mailing Address - Country:US
Mailing Address - Phone:412-828-4409
Mailing Address - Fax:412-828-4647
Practice Address - Street 1:4727 FRIENDSHIP AVE STE 140
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1778
Practice Address - Country:US
Practice Address - Phone:412-235-5885
Practice Address - Fax:412-235-5886
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP004291M363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care