1437447059 NPI number — MRS. JANICE M. CARSELLO MSN, CRNP

Table of content: MRS. JANICE M. CARSELLO MSN, CRNP (NPI 1437447059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437447059 NPI number — MRS. JANICE M. CARSELLO MSN, CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARSELLO
Provider First Name:
JANICE
Provider Middle Name:
M.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHRISTINZIO
Provider Other First Name:
JANICE
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437447059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 WOLF ST
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19148-2912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-334-5315
Provider Business Mailing Address Fax Number:
215-334-5305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 WOLF ST
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19148-2912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-334-5315
Provider Business Practice Location Address Fax Number:
215-334-5305
Provider Enumeration Date:
07/17/2011

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: 363L00000X , with the licence number:  SP011315 , 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)

  • Identifier: 102888480 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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