Provider Demographics
NPI:1912459447
Name:MUTNANSKY, NICOLE (CNM, MSN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MUTNANSKY
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-4713
Mailing Address - Country:US
Mailing Address - Phone:412-321-6880
Mailing Address - Fax:412-321-7070
Practice Address - Street 1:2825 PENN AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-4713
Practice Address - Country:US
Practice Address - Phone:412-321-6880
Practice Address - Fax:412-321-7070
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019347363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health