Provider Demographics
NPI:1396755690
Name:DIBATTISTA, NICHOLA KIM (PA-C)
Entity type:Individual
Prefix:
First Name:NICHOLA
Middle Name:KIM
Last Name:DIBATTISTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 THORNTON RD
Mailing Address - Street 2:
Mailing Address - City:UPPER CHICHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19061-3127
Mailing Address - Country:US
Mailing Address - Phone:248-980-8423
Mailing Address - Fax:
Practice Address - Street 1:201 REECEVILLE RD
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-1542
Practice Address - Country:US
Practice Address - Phone:610-383-8518
Practice Address - Fax:610-384-2597
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052355363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1059459OtherNAT'L COMM CERT OF PA
1059459OtherNAT'L COMM CERT OF PA