Provider Demographics
NPI:1750377602
Name:NICOTERI, JO ANN LOUISE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:JO ANN
Middle Name:LOUISE
Last Name:NICOTERI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1574
Mailing Address - Country:US
Mailing Address - Phone:570-941-4345
Mailing Address - Fax:570-941-4298
Practice Address - Street 1:1130 MULBERRY ST
Practice Address - Street 2:UNIVERSITY OF SCRANTON STUDENT HEALTH SERVICES
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2125
Practice Address - Country:US
Practice Address - Phone:570-941-7667
Practice Address - Fax:570-941-4298
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP000960-B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily