Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | SP003804M | PA |
NPI | 1003152562 |
---|---|
Provider Name | Charmaine Pykosh |
First Address | Pittsburgh, PA 15213-2536 |
Second Address | Pittsburgh, PA 15232-1304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2013 |
Last Update Date | 15/06/2021 |