Provider Demographics
NPI:1750605036
Name:FRICK, NICOLE M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:M
Last Name:FRICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5126 ROUTE 30
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-7835
Mailing Address - Country:US
Mailing Address - Phone:724-836-3027
Mailing Address - Fax:724-836-3029
Practice Address - Street 1:5126 ROUTE 30
Practice Address - Street 2:SUITE 300
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-7835
Practice Address - Country:US
Practice Address - Phone:724-836-3027
Practice Address - Fax:724-836-3029
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052794363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA052794OtherMA NUMBER