Healthcare Provider Details

I. General information

NPI: 1518391663
Provider Name (Legal Business Name): NANCY D'AMICO NICKLES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WOODBINE LN
DANVILLE PA
17821-8029
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-5600
  • Fax: 570-271-5851
Mailing address:
  • Phone: 570-271-6144
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD424757
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: