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General NPI Number Information
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NPI Number | 1407689870
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Entity Type | Individual
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Provider Name | MARY JEEN NICOLA CRNP
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Gender | Female
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Dates
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Enumeration Date | 08/21/2024
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 905 SPRUCE ST
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City | IRWIN
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State | PA
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Zip | 15642-3683
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Country | US
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Telephone | 724-864-9595
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Fax | 724-864-9860
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Provider Business Mailing Address
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Address Line | 905 SPRUCE ST
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City | IRWIN
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State | PA
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Zip | 15642-3683
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Country | US
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Telephone | 724-864-9595
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Fax | 724-864-9860
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP030310
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11034854
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License Number State | FL
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