Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | RN531625 | PA |
Y | 363L00000X | Nurse Practitioner | SP014223 | PA |
NPI | 1013153626 |
---|---|
Provider Name | Dawn Decicco |
First Address | Kittanning, PA 16201-2416 |
Second Address | Kittanning, PA 16201-2416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2009 |
Last Update Date | 08/03/2017 |