Provider Demographics
NPI:1134452055
Name:CRISCITELLO, AMY D (CRNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:CRISCITELLO
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 1:1348 GINTER MORANN HWY
Mailing Address - Street 2:
Mailing Address - City:HOUTZDALE
Mailing Address - State:PA
Mailing Address - Zip Code:16651-9541
Mailing Address - Country:US
Mailing Address - Phone:814-553-5173
Mailing Address - Fax:
Practice Address - Street 1:1033 TURNPIKE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-3061
Practice Address - Country:US
Practice Address - Phone:814-768-2137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010448363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health