Provider Demographics
NPI:1053778720
Name:HARBISON, NICOLETTE (CRNA)
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:
Last Name:HARBISON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:NICOLETTE
Other - Middle Name:
Other - Last Name:CHICKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:119 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3033
Mailing Address - Country:US
Mailing Address - Phone:304-233-2455
Mailing Address - Fax:304-234-8960
Practice Address - Street 1:1 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6379
Practice Address - Country:US
Practice Address - Phone:304-233-2455
Practice Address - Fax:304-233-6073
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN608325367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered