Provider Demographics
NPI:1689640930
Name:EYSTER, ANTONINA (CRNP)
Entity Type:Individual
Prefix:
First Name:ANTONINA
Middle Name:
Last Name:EYSTER
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 1:9335 MCKNIGHT RD FL 1
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5903
Mailing Address - Country:US
Mailing Address - Phone:412-847-2020
Mailing Address - Fax:412-847-2025
Practice Address - Street 1:9335 MCKNIGHT RD FL 1
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5903
Practice Address - Country:US
Practice Address - Phone:412-847-2020
Practice Address - Fax:412-847-2025
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP004335W363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022592700001Medicaid
PA028972NJKMedicare PIN
PA1022592700001Medicaid