Provider Demographics
NPI:1437917291
Name:YAKICIC, MICHELE LEE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEE
Last Name:YAKICIC
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:LEE
Other - Last Name:STANSFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:158 BETZ RD
Mailing Address - Street 2:
Mailing Address - City:SIDMAN
Mailing Address - State:PA
Mailing Address - Zip Code:15955-3400
Mailing Address - Country:US
Mailing Address - Phone:814-525-6741
Mailing Address - Fax:
Practice Address - Street 1:429 MANOR DR STE 10
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4917
Practice Address - Country:US
Practice Address - Phone:814-472-6060
Practice Address - Fax:814-472-1293
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN504303L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse