Provider Demographics
NPI:1104234335
Name:PERRY, MARIBETH A (CRNP)
Entity type:Individual
Prefix:
First Name:MARIBETH
Middle Name:A
Last Name:PERRY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARIBETH
Other - Middle Name:A
Other - Last Name:SCHIAVONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1307 FEDERAL ST STE B100
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4761
Mailing Address - Country:US
Mailing Address - Phone:412-359-8900
Mailing Address - Fax:412-359-8977
Practice Address - Street 1:1307 FEDERAL ST STE B100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4761
Practice Address - Country:US
Practice Address - Phone:412-359-8900
Practice Address - Fax:412-359-8977
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013963363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102965543Medicaid
12727276OtherCAQH
12727276OtherCAQH