Individual
LISA DICICCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN CRNP
Contact information
Practice address
3400 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-5127
(215) 662-4000
Mailing address
10945 KIPLING LN, PHILADELPHIA, PA 19154-4241
(215) 939-6748
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
SP031736
PA
Other
Enumeration date
03/03/2025
Last updated
07/31/2025
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