Healthcare Provider Details

I. General information

NPI: 1710690425
Provider Name (Legal Business Name): MARCELLA NORTHERN MSN, RN, FNP, CNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CORPORATE PLAZA DR
NEWPORT BEACH CA
92660-7985
US

IV. Provider business mailing address

26742 MOORE OAKS RD
LAGUNA HILLS CA
92653-7559
US

V. Phone/Fax

Practice location:
  • Phone: 949-722-7038
  • Fax:
Mailing address:
  • Phone: 949-228-0259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023507
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95182844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: