Provider Demographics
NPI:1669047692
Name:KYAZZE, JOSEPHINE (CRPN)
Entity type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:
Last Name:KYAZZE
Suffix:
Gender:F
Credentials:CRPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 SAUNDERS STATION RD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-4433
Mailing Address - Country:US
Mailing Address - Phone:412-337-8012
Mailing Address - Fax:
Practice Address - Street 1:2380 RECOVERY CENTERS OF AMERICA
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146
Practice Address - Country:US
Practice Address - Phone:412-337-8012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily