Provider Demographics
NPI:1093357915
Name:SIDICK, VANESSA ANN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:ANN
Last Name:SIDICK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:VANESSA
Other - Middle Name:ANN
Other - Last Name:FEDERICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:109 JULIANNA DR
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-3764
Mailing Address - Country:US
Mailing Address - Phone:412-965-2042
Mailing Address - Fax:
Practice Address - Street 1:4 PEARTREE WAY
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-1954
Practice Address - Country:US
Practice Address - Phone:724-728-3575
Practice Address - Fax:724-770-7964
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020517363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily