MEDICARE: NICOLE MARIE DEAN CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	SP024270	PA

General Provider Information

NPI Number	:	1528735255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE DEAN CRNP

Provider Business Mailing Address
First Line	:	110 ANCHOR CT
Second Line	:
City	:	MC DONALD
State	:	PA
Zip	:	15057-2199
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 CORAOPOLIS HEIGHTS RD STE G1
Second Line	:
City	:	MOON TWP
State	:	PA
Zip	:	15108-4307
Country	:	US
Telephone Number	:	412-329-2642
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	03/07/2025

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