Provider Demographics
NPI:1356636252
Name:DERISO, LOUISE (MSN, CRNP)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:
Last Name:DERISO
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 GREENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1332
Mailing Address - Country:US
Mailing Address - Phone:412-242-0155
Mailing Address - Fax:
Practice Address - Street 1:412 GREENDALE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1332
Practice Address - Country:US
Practice Address - Phone:412-242-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP000609C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health