Provider Demographics
NPI:1295989143
Name:BLOOMBURG, DANA MINUCCI (CRNP)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MINUCCI
Last Name:BLOOMBURG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:MINUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2825 PENN AVENUE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222
Mailing Address - Country:US
Mailing Address - Phone:412-321-6880
Mailing Address - Fax:412-321-7070
Practice Address - Street 1:2825 PENN AVENUE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222
Practice Address - Country:US
Practice Address - Phone:412-321-6880
Practice Address - Fax:412-321-7070
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010007363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner