MEDICARE: KIRSTEN S PORCELLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	313893	NY

General Provider Information

NPI Number	:	1104504901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN S PORCELLA

Provider Business Mailing Address
First Line	:	601 W 115TH ST APT 95
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-7710
Country	:	US
Telephone Number	:	808-205-3056
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 W 115TH ST APT 95
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-7710
Country	:	US
Telephone Number	:	808-205-3056
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2023
Last Update Date	:	07/12/2023

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Directions to “ KIRSTEN S PORCELLA ” Practice Location

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