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NPI Profile for SCOTT J CICCIARELLI JR in PEORIA, IL.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Surgical |
363AS0400X | 97 | Physician Assistant |
| NPI Number | 1801485271 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 01/11/2021 | |
| Last updated | 06/13/2022 - About 4 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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SCOTT J CICCIARELLI JR
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SCOTT J CICCIARELLI JR