Individual
MARY JEEN NICOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
905 SPRUCE ST, IRWIN, PA 15642-3683
(724) 864-9595
(724) 864-9860
Mailing address
905 SPRUCE ST, IRWIN, PA 15642-3683
(724) 864-9595
(724) 864-9860
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN11034854
FL
363L00000X
Nurse Practitioner
Primary
SP030310
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1044722540001
—
PA
01
—
850277
PA BS
PA
01
—
CA3219
PALMETTO GBA - RAILROAD MEDICARE
PA
Enumeration date
08/21/2024
Last updated
07/22/2025
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