Healthcare Provider Details

I. General information

NPI: 1396387114
Provider Name (Legal Business Name): JUSTINE MICHAEL SICARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 E NORTH AVE STE 300
PITTSBURGH PA
15212-4771
US

IV. Provider business mailing address

490 E NORTH AVE STE 300
PITTSBURGH PA
15212-4771
US

V. Phone/Fax

Practice location:
  • Phone: 412-322-7202
  • Fax: 412-322-2144
Mailing address:
  • Phone: 412-322-7202
  • Fax: 412-322-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberSP020972
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: