Provider Demographics
NPI:1366834343
Name:DICANIO, MARLA JEAN (CNA, STNA, LPN)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:JEAN
Last Name:DICANIO
Suffix:
Gender:F
Credentials:CNA, STNA, LPN
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:JEAN
Other - Last Name:MCCUTCHEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:PO BOX 401
Mailing Address - Street 2:
Mailing Address - City:HOOKSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15050-0401
Mailing Address - Country:US
Mailing Address - Phone:724-573-0886
Mailing Address - Fax:
Practice Address - Street 1:1000 MASONIC DR
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-2328
Practice Address - Country:US
Practice Address - Phone:412-741-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159420-1164X00000X
OH401633600414376K00000X
PA10065352376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No164X00000XNursing Service ProvidersLicensed Vocational Nurse