Provider Demographics
NPI:1033707906
Name:JAICKS, NANCIE G (RN, BSN)
Entity Type:Individual
Prefix:
First Name:NANCIE
Middle Name:G
Last Name:JAICKS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 BRANDI LYNN LN
Mailing Address - Street 2:
Mailing Address - City:EVANS CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16033-7709
Mailing Address - Country:US
Mailing Address - Phone:724-272-9156
Mailing Address - Fax:
Practice Address - Street 1:337 BRANDI LYNN LN
Practice Address - Street 2:
Practice Address - City:EVANS CITY
Practice Address - State:PA
Practice Address - Zip Code:16033-7709
Practice Address - Country:US
Practice Address - Phone:724-272-9156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN544261163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN544261Medicaid