Healthcare Provider Details

I. General information

NPI: 1366834343
Provider Name (Legal Business Name): MARLA JEAN DICANIO CNA, STNA, LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARLA JEAN MCCUTCHEON LPN

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MASONIC DR
SEWICKLEY PA
15143-2328
US

IV. Provider business mailing address

PO BOX 401
HOOKSTOWN PA
15050-0401
US

V. Phone/Fax

Practice location:
  • Phone: 412-741-1400
  • Fax:
Mailing address:
  • Phone: 724-573-0886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number401633600414
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number10065352
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number159420-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: