Healthcare Provider Details

I. General information

NPI: 1013323039
Provider Name (Legal Business Name): NICHOLAS E SIPES PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-3261
  • Fax: 814-375-3397
Mailing address:
  • Phone: 814-375-6549
  • Fax: 814-372-2864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA056985
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: