Healthcare Provider Details

I. General information

NPI: 1104288141
Provider Name (Legal Business Name): BRITTANY MARIE-NOELLE CIARAMELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W 32ND ST STE 102
JOPLIN MO
64804-1528
US

IV. Provider business mailing address

1801 W 32ND ST STE 102
JOPLIN MO
64804-1528
US

V. Phone/Fax

Practice location:
  • Phone: 417-622-0648
  • Fax:
Mailing address:
  • Phone: 417-622-0648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number20200022867
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1042
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00367000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: