Provider Demographics
NPI:1609335371
Name:CETRA, CARISSA ANN (CRNP)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:ANN
Last Name:CETRA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:ANN
Other - Last Name:VYHONSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 E NORTH AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:412-359-3319
Mailing Address - Fax:412-359-4136
Practice Address - Street 1:320 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-359-3319
Practice Address - Fax:412-359-4136
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020126363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103650861Medicaid