Provider Demographics
NPI:1164912986
Name:DICICCO, ANNA MARIA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIA
Last Name:DICICCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5621 22ND AVE NW APT 319
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3471
Mailing Address - Country:US
Mailing Address - Phone:206-553-9872
Mailing Address - Fax:
Practice Address - Street 1:5621 22ND AVE NW APT 319
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3471
Practice Address - Country:US
Practice Address - Phone:206-553-9872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula