Provider Demographics
NPI:1023083110
Name:SICHAK, MARY ELLEN (CRNA)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLEN
Last Name:SICHAK
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 1:3118 ESTATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15071
Mailing Address - Country:US
Mailing Address - Phone:412-418-3088
Mailing Address - Fax:
Practice Address - Street 1:1000 DUTCH RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009
Practice Address - Country:US
Practice Address - Phone:724-773-4621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN296245L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS56654Medicare UPIN
PA010526FEVMedicare ID - Type Unspecified