Provider Demographics
NPI:1114227683
Name:IGNATIUS, NICOLE (DO)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:IGNATIUS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:SWEITZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:90 BEAVER DR STE 121D
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2441
Mailing Address - Country:US
Mailing Address - Phone:814-503-4837
Mailing Address - Fax:
Practice Address - Street 1:90 BEAVER DR STE 121D
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2441
Practice Address - Country:US
Practice Address - Phone:814-503-4837
Practice Address - Fax:814-503-4697
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT013241207Q00000X
PAOS016283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102769793Medicaid
PA261144OtherPECOS