Provider Demographics
NPI:1255391264
Name:MCNALLY, JOANNA ROBERTA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:ROBERTA
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:JOANNA
Other - Middle Name:ROBERTA
Other - Last Name:DAUGERDAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1630 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15210-1737
Mailing Address - Country:US
Mailing Address - Phone:412-641-1230
Mailing Address - Fax:412-488-3890
Practice Address - Street 1:1630 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15210-1737
Practice Address - Country:US
Practice Address - Phone:412-641-1230
Practice Address - Fax:412-488-3890
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN518829L163W00000X
PASP008329363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q28660Medicare UPIN
PA082074Medicare ID - Type Unspecified