Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | SP020704 | PA |
Y | 363LG0600X | Nurse Practitioner - Gerontology | SP020704 | PA |
NPI | 1053967950 |
---|---|
Provider Name | Kathleen M Janosco |
First Address | Pittsburgh, PA 15212-4756 |
Second Address | Pittsburgh, PA 15212-4756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2019 |
Last Update Date | 01/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14602185 | CAQH (01) |