Provider Demographics
NPI:1801594296
Name:VIS, JENNIFER ASHLEY (CRNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ASHLEY
Last Name:VIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ASHLEY
Other - Last Name:STAUDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3459 5TH AVE STE 88
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3236
Mailing Address - Country:US
Mailing Address - Phone:412-647-9835
Mailing Address - Fax:
Practice Address - Street 1:3459 5TH AVE STE 88
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3236
Practice Address - Country:US
Practice Address - Phone:412-647-9835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027135363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner