Individual
CARLY J MCNUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2580 HAYMAKER RD STE 304, MONROEVILLE, PA 15146-3500
(412) 858-3070
(412) 858-3076
Mailing address
2580 HAYMAKER RD STE 304, MONROEVILLE, PA 15146-3500
(412) 858-3070
(412) 858-3076
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MA055049
PA
363AS0400X
Surgical Physician Assistant
Primary
MA055049
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103195249
—
PA
01
—
13576963
CAQH
—
Enumeration date
11/08/2011
Last updated
10/05/2020
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