Provider Demographics
NPI:1710602206
Name:DICICCO, ANNA (DNP, AGNP-BC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:DICICCO
Suffix:
Gender:F
Credentials:DNP, AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HEALTH SERVICES DR
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-9600
Mailing Address - Country:US
Mailing Address - Phone:815-756-5255
Mailing Address - Fax:815-756-9944
Practice Address - Street 1:10 HEALTH SERVICES DR
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9600
Practice Address - Country:US
Practice Address - Phone:815-756-5255
Practice Address - Fax:815-756-9944
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL209026285363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology