Provider Demographics
NPI:1679154736
Name:SURGENAVIC, VICKI LYNN (CRNP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:SURGENAVIC
Suffix:
Gender:F
Credentials:CRNP
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Mailing Address - Street 1:1925 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16102-1622
Mailing Address - Country:US
Mailing Address - Phone:724-544-2840
Mailing Address - Fax:
Practice Address - Street 1:111 HAZEL LN STE 300
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1253
Practice Address - Country:US
Practice Address - Phone:412-749-7330
Practice Address - Fax:412-749-7339
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP0229542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty