Provider Demographics
NPI:1417108937
Name:YANICKO, WILLIAM A (FD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:YANICKO
Suffix:
Gender:M
Credentials:FD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:RUSSELLTON
Mailing Address - State:PA
Mailing Address - Zip Code:15076-0021
Mailing Address - Country:US
Mailing Address - Phone:724-265-3800
Mailing Address - Fax:724-265-3888
Practice Address - Street 1:23 MCKRELL RD
Practice Address - Street 2:
Practice Address - City:RUSSELLTON
Practice Address - State:PA
Practice Address - Zip Code:15076-1302
Practice Address - Country:US
Practice Address - Phone:724-265-3800
Practice Address - Fax:724-265-3888
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAFD-013014-L176P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176P00000XOther Service ProvidersFuneral Director