Provider Demographics
NPI:1679666150
Name:ROCCO, NICHOLAS M (CRNA)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:M
Last Name:ROCCO
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:423 SCRANTON CARBONDALE HWY
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1115
Practice Address - Country:US
Practice Address - Phone:570-558-6372
Practice Address - Fax:570-207-2075
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PARN503942L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA111812VKCMedicare PIN