Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0600X | Clinical Neurophysiologist | SP009838 | PA |
Y | 363LA2200X | Nurse Practitioner - Adult Health | TP006931C | PA |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | SP009838 | PA |
NPI | 1639395395 |
---|---|
Provider Name | Ms. Joan M Cicchiello |
First Address | Mount Carmel, PA 17851-1303 |
Second Address | Mount Carmel, PA 17851-1803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 28/05/2015 |