Provider Demographics
NPI:1194863894
Name:ELLENBERGER, BETSY JAN (CRNP)
Entity Type:Individual
Prefix:MS
First Name:BETSY
Middle Name:JAN
Last Name:ELLENBERGER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:HARRISON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15636-1508
Mailing Address - Country:US
Mailing Address - Phone:412-551-6278
Mailing Address - Fax:
Practice Address - Street 1:628 NW UPMC MONTEFIORE
Practice Address - Street 2:3459 FIFTH AVE
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2582
Practice Address - Country:US
Practice Address - Phone:412-692-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA61402171363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care