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General NPI Number Information
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NPI Number | 1154562536
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Entity Type | Individual
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Provider Name | LISA A. CHICHERICCO-SLOAD CRNA
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Gender | Female
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Dates
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Enumeration Date | 03/16/2009
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 1613 HARRISON PKWY STE 200
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City | SUNRISE
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State | FL
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Zip | 33323-2896
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Country | US
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Telephone | 800-437-2672
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Fax |
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Provider Business Mailing Address
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Address Line | 11368 SW MOUNTAIN ASH CIR
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City | PORT ST LUCIE
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State | FL
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Zip | 34987-2460
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Country | US
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Telephone | 610-721-5008
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 081646
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License Number State | PA
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