Provider Demographics
NPI:1053419853
Name:PISTILLI, RENEE D (CNM)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:D
Last Name:PISTILLI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MISS
Other - First Name:RENEE
Other - Middle Name:M
Other - Last Name:DIEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:2050 S QUEEN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4829
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2050 S QUEEN ST
Practice Address - Street 2:STE 200
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4829
Practice Address - Country:US
Practice Address - Phone:717-812-2316
Practice Address - Fax:717-848-5540
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010077367A00000X, 176B00000X
PARN559129163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101154612Medicaid
PA1542778OtherGATEWAY-WMG
MD974233OtherCAREFIRST MD BCBS
PA215371FLTMedicare PIN