Healthcare Provider Details

I. General information

NPI: 1851171078
Provider Name (Legal Business Name): ANNIE FELLAH JULES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COOPER PLZ DEPT OF
CAMDEN NJ
08103-1461
US

IV. Provider business mailing address

3400 SPRUCE ST
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2425
  • Fax:
Mailing address:
  • Phone: 800-789-7366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN705564
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: