Provider Demographics
NPI:1700862216
Name:NIGRO, NICKI L (DPM)
Entity Type:Individual
Prefix:DR
First Name:NICKI
Middle Name:L
Last Name:NIGRO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 UNION AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2133
Mailing Address - Country:US
Mailing Address - Phone:724-226-0544
Mailing Address - Fax:724-226-2172
Practice Address - Street 1:1601 UNION AVE
Practice Address - Street 2:SUITE B
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2133
Practice Address - Country:US
Practice Address - Phone:724-226-0544
Practice Address - Fax:724-226-2172
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003358L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA 1563719Medicaid
PA613236Medicare PIN
U24482Medicare UPIN