Provider Demographics
NPI:1467501205
Name:DECICCO, ELIZABETH A (RN MSN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:DECICCO
Suffix:
Gender:F
Credentials:RN MSN
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Mailing Address - Street 1:111 HAZEL LN
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1253
Mailing Address - Country:US
Mailing Address - Phone:412-749-7613
Mailing Address - Fax:
Practice Address - Street 1:300 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-2416
Practice Address - Country:US
Practice Address - Phone:724-543-2941
Practice Address - Fax:724-543-4177
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2018-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PARN189666L163WP0808X
PASP011225363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health