Healthcare Provider Details

I. General information

NPI: 1982325452
Provider Name (Legal Business Name): MARY-JO DICKINSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3394 SAXONBURG BLVD STE 600
GLENSHAW PA
15116-3169
US

IV. Provider business mailing address

2 ALLEGHENY CTR STE 530
PITTSBURGH PA
15212-5404
US

V. Phone/Fax

Practice location:
  • Phone: 412-767-0707
  • Fax: 724-482-4466
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP026155
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: