Healthcare Provider Details

I. General information

NPI: 1316930084
Provider Name (Legal Business Name): NANCY TAYLOR CICAK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 10/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 N.COLLEGE ST. DICKINSON COLLEGE HEALTH SERVICES
CARLISLE PA
17013-2727
US

IV. Provider business mailing address

28 N. COLLEGE ST.
CARLISLE PA
17013-2727
US

V. Phone/Fax

Practice location:
  • Phone: 717-245-1835
  • Fax: 717-245-1938
Mailing address:
  • Phone: 717-245-1835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN227137L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberTP000441G
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: