Provider Demographics
NPI:1649203969
Name:HICE, MARY ELLEN (CRNA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:HICE
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 1:100 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-2130
Mailing Address - Country:US
Mailing Address - Phone:814-676-7843
Mailing Address - Fax:814-676-7838
Practice Address - Street 1:100 FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-2130
Practice Address - Country:US
Practice Address - Phone:814-676-7843
Practice Address - Fax:814-676-7838
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2012-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN153354L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019607640001Medicaid
PA072952OtherBLUE SHIELD BLK 33 PIN
PA312161OtherUPMC BLK 33 PIN
PADD4802OtherPALMETTO GBA BLK 33 GRP
PA050555457OtherCOMMERCIAL BLK 33 GRP
PA994588OtherBLUE SHIELD BLK 33 PIN
PAP00230587OtherPALMETTO GBA BLK 33 PIN
PA0019613040001Medicaid
PA050555457OtherUPMC BLK 33 GRP
PA1520056OtherBLUE SHIELD BLK 33 GRP
PA808862OtherBLUE SHIELD BLK 33 GRP
PAR88943OtherCOMMERCIAL BLK 33 PIN
PADD4802OtherPALMETTO GBA BLK 33 GRP
PAP00230587OtherPALMETTO GBA BLK 33 PIN
PA312161OtherUPMC BLK 33 PIN