Provider Demographics
NPI:1558846485
Name:DESALLE, LAUREN MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:DESALLE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:LASKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:200 QUINN DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15275-1055
Mailing Address - Country:US
Mailing Address - Phone:412-264-9500
Mailing Address - Fax:412-264-8999
Practice Address - Street 1:200 QUINN DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15275-1055
Practice Address - Country:US
Practice Address - Phone:412-264-9500
Practice Address - Fax:412-264-8999
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019298363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4894925OtherAETNA PIN
PA103587089Medicaid
PA7A0137OtherMEDICARE