Provider Demographics
NPI:1932545563
Name:FERENCAK, NICOLE BRIANNE (RN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:BRIANNE
Last Name:FERENCAK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 N FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-5891
Mailing Address - Country:US
Mailing Address - Phone:724-222-5433
Mailing Address - Fax:724-228-7619
Practice Address - Street 1:2114 N FRANKLIN DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-5891
Practice Address - Country:US
Practice Address - Phone:724-222-5433
Practice Address - Fax:724-228-7619
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN635334163W00000X
WV8440163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse