Healthcare Provider Details

I. General information

NPI: 1467501205
Provider Name (Legal Business Name): ELIZABETH A DECICCO R.N. M.S.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S JEFFERSON ST
KITTANNING PA
16201-2416
US

IV. Provider business mailing address

111 HAZEL LN SUITE 300
SEWICKLEY PA
15143-1253
US

V. Phone/Fax

Practice location:
  • Phone: 724-543-2941
  • Fax: 724-543-4177
Mailing address:
  • Phone: 412-749-7613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN189666L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP011225
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: