Healthcare Provider Details

I. General information

NPI: 1467893156
Provider Name (Legal Business Name): NICOLE RENEE SUCEVICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

0 UNIVERSITY DRIVE C
PITTSBURGH PA
15240-1001
US

IV. Provider business mailing address

0 UNIVERSITY DRIVE C
PITTSBURGH PA
15240-1001
US

V. Phone/Fax

Practice location:
  • Phone: 412-360-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN619644
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: