MEDICARE: KATHERINE H MARCELLA PNP

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	363LP0200X	Pediatric Nurse Practitioner	606596	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2082209-PC	OTHER		PNP CERTIFICATION

General Provider Information

NPI Number	:	1831330497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE H MARCELLA PNP

Provider Business Mailing Address
First Line	:	1103 N ELM ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-2938
Country	:	US
Telephone Number	:	940-566-5437
Fax Number	:	940-320-2709

Provider Business Practice Location Address
First Line	:	1103 N ELM ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-2938
Country	:	US
Telephone Number	:	940-566-5437
Fax Number	:	940-320-2709

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

Provider Enumeration Date	:	03/11/2009
Last Update Date	:	06/25/2014

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