1750152948 NPI number — MS. LYNNE ROCHELLE HRICIK

Table of content: MS. LYNNE ROCHELLE HRICIK (NPI 1750152948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750152948 NPI number — MS. LYNNE ROCHELLE HRICIK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HRICIK
Provider First Name:
LYNNE
Provider Middle Name:
ROCHELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DURNELL
Provider Other First Name:
LYNNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1750152948
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 JACKSON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREEDOM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15042-2842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-774-3050
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 EXECUTIVE DR STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANBERRY TWP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16066-6405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-772-9797
Provider Business Practice Location Address Fax Number:
724-772-3309
Provider Enumeration Date:
01/16/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207QA0505X , with the licence number:  MA00946L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: MA000946L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 1010116 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)