Provider Demographics
NPI:1871226886
Name:WILTROUT, JENA (CRNP)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:WILTROUT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 HAYMAKER RD FL 2
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3516
Mailing Address - Country:US
Mailing Address - Phone:412-373-4411
Mailing Address - Fax:412-373-4677
Practice Address - Street 1:2626 HAYMAKER RD FL 2
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3516
Practice Address - Country:US
Practice Address - Phone:412-373-4411
Practice Address - Fax:412-373-4677
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP025868OtherPALS