Provider Demographics
NPI:1174074629
Name:IRICK, NICOLE A (CRNA)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:A
Last Name:IRICK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 N SADDLEBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-2329
Mailing Address - Country:US
Mailing Address - Phone:412-848-7973
Mailing Address - Fax:
Practice Address - Street 1:140 JOHN ROBERT THOMAS DR
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2656
Practice Address - Country:US
Practice Address - Phone:610-280-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN648140367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered