Individual
MRS. NICOLE L LANDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2580 HAYMAKER RD STE 102, MONROEVILLE, PA 15146-3500
(412) 858-3070
Mailing address
2580 HAYMAKER RD STE 102, MONROEVILLE, PA 15146-3500
(412) 858-3070
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA059082
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14034537
CAQH
—
Enumeration date
05/23/2017
Last updated
11/18/2024
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