Healthcare Provider Details

I. General information

NPI: 1366827057
Provider Name (Legal Business Name): ELLEN RICCIO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 SPRINGER RD
FREEDOM PA
15042-2187
US

IV. Provider business mailing address

95 SPRINGER RD
FREEDOM PA
15042-2187
US

V. Phone/Fax

Practice location:
  • Phone: 724-333-7034
  • Fax:
Mailing address:
  • Phone: 724-333-7034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015226
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP034140
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN568111
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: