Provider Demographics
NPI:1356856215
Name:DESIMONE, MOLLIE ALANNA (CRNP)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:ALANNA
Last Name:DESIMONE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:
Other - Last Name:SPITLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:810 CLAIRTON BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-5511
Mailing Address - Country:US
Mailing Address - Phone:412-650-1170
Mailing Address - Fax:412-650-1171
Practice Address - Street 1:810 CLAIRTON BLVD STE 400
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-5511
Practice Address - Country:US
Practice Address - Phone:412-650-1170
Practice Address - Fax:412-650-1171
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103458724Medicaid
14199141OtherCAQH