Provider Demographics
NPI:1114020450
Name:SCANLON, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:SCANLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:HICKS
Other - Last Name:SCANLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:611 CARTERS GROVE DR
Mailing Address - Street 2:SUITE 2103
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-9567
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NW 628 MONTEFIORE UNIVERSITY HOSPITAL
Practice Address - Street 2:SUITE 2103
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-692-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP006338M363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA045315LQ2Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION #
PAP24063Medicare UPIN