Provider Demographics
NPI:1497735989
Name:TRIDICO, JOANNE L (CRNA)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:L
Last Name:TRIDICO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 COOK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-1208
Mailing Address - Country:US
Mailing Address - Phone:814-723-2075
Mailing Address - Fax:
Practice Address - Street 1:2 W CRESCENT PARK
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2111
Practice Address - Country:US
Practice Address - Phone:814-723-3300
Practice Address - Fax:814-723-8515
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN124942L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA601786OtherHIGHMARK