Healthcare Provider Details

I. General information

NPI: 1467416701
Provider Name (Legal Business Name): JANET RUTH BRICKER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 08/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 PEACH ST SUITE 3100
ERIE PA
16509-2601
US

IV. Provider business mailing address

1 LECOM PL
ERIE PA
16505-2571
US

V. Phone/Fax

Practice location:
  • Phone: 814-868-7830
  • Fax: 814-868-2138
Mailing address:
  • Phone:
  • Fax: 814-868-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN247525L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberSP001528G
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: