Provider Demographics
NPI:1376540641
Name:DICERBO, NANCY (FNP-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DICERBO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 WASHINGTON AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1098
Mailing Address - Country:US
Mailing Address - Phone:518-489-4704
Mailing Address - Fax:518-489-0512
Practice Address - Street 1:1365 WASHINGTON AVE
Practice Address - Street 2:STE 300
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1098
Practice Address - Country:US
Practice Address - Phone:518-489-4704
Practice Address - Fax:518-489-0512
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01331402Medicaid
S23117Medicare UPIN
RA2220Medicare ID - Type Unspecified