Provider Demographics
NPI:1265540942
Name:PETRUSKA, PAULA JEAN (CRNP)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:JEAN
Last Name:PETRUSKA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:PAULA
Other - Middle Name:JEAN
Other - Last Name:NEEDHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:746 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15229-1205
Mailing Address - Country:US
Mailing Address - Phone:412-369-0777
Mailing Address - Fax:412-688-6912
Practice Address - Street 1:UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15240
Practice Address - Country:US
Practice Address - Phone:412-688-6322
Practice Address - Fax:412-688-6912
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily