Provider Demographics
NPI:1730163155
Name:TESTANI, NICOLE MARIE (DPM)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIE
Last Name:TESTANI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:AMATO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 526
Mailing Address - Street 2:
Mailing Address - City:BIGLERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17307-0526
Mailing Address - Country:US
Mailing Address - Phone:717-677-9288
Mailing Address - Fax:717-677-4196
Practice Address - Street 1:23 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BIGLERVILLE
Practice Address - State:PA
Practice Address - Zip Code:17307
Practice Address - Country:US
Practice Address - Phone:717-677-9288
Practice Address - Fax:717-677-4196
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005722213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011550480004Medicaid
PA1011550480003Medicaid
PA1011550480002Medicaid
PA1011550480001Medicaid
PA1149270003Medicare ID - Type UnspecifiedNHIC DME-PAXTONIA SITE
PA079253Medicare ID - Type Unspecified
PA1011550480004Medicaid
U99880Medicare UPIN
PA1149270004Medicare ID - Type UnspecifiedNHIC DME-LONDONDERRY SITE
PA1149270001Medicare ID - Type UnspecifiedNHIC DME-BIGLERVILLE SITE