Healthcare Provider Details

I. General information

NPI: 1841093119
Provider Name (Legal Business Name): OLIVIA ANN BICKMORE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLIVIA ANN GRAVANTE

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 COUNTRY CLUB RD
MONONGAHELA PA
15063-1013
US

IV. Provider business mailing address

818 NORTH AVE
VERONA PA
15147-2125
US

V. Phone/Fax

Practice location:
  • Phone: 724-258-1000
  • Fax:
Mailing address:
  • Phone: 412-638-0316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP032342
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: