Healthcare Provider Details

I. General information

NPI: 1851613913
Provider Name (Legal Business Name): JEANNE CICERO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 STATE ST SUITE D
ERIE PA
16501-1803
US

IV. Provider business mailing address

1031 STATE ST SUITE D
ERIE PA
16501-1803
US

V. Phone/Fax

Practice location:
  • Phone: 814-455-7827
  • Fax: 814-455-7831
Mailing address:
  • Phone: 814-455-7827
  • Fax: 814-455-7831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN328365L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: