Healthcare Provider Details

I. General information

NPI: 1497958136
Provider Name (Legal Business Name): LAURIE ANNE ROCKELLI PHD, CRNP-PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E MAIN ST
SALISBURY MD
21804-5020
US

IV. Provider business mailing address

540 RIVERSIDE DR STE 8
SALISBURY MD
21801-5352
US

V. Phone/Fax

Practice location:
  • Phone: 410-341-3420
  • Fax: 410-341-3397
Mailing address:
  • Phone: 410-548-3333
  • Fax: 410-548-3341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR093795
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR093795
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: