Provider Demographics
NPI:1487644530
Name:DENINNO, THERESE IRENE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:IRENE
Last Name:DENINNO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TRIA
Other - Middle Name:
Other - Last Name:DENINNO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:107 FERNVUE DR
Mailing Address - Street 2:
Mailing Address - City:MOON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-1106
Mailing Address - Country:US
Mailing Address - Phone:412-299-0474
Mailing Address - Fax:
Practice Address - Street 1:1000 DUTCH RIDGE RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-9727
Practice Address - Country:US
Practice Address - Phone:724-773-7658
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050686363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant