Healthcare Provider Details

I. General information

NPI: 1962776716
Provider Name (Legal Business Name): NP ADVANCED WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2012
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 CROATAN PL
PHILA PA
19145-5403
US

IV. Provider business mailing address

1635 CROATAN PL
PHILA PA
19145-5403
US

V. Phone/Fax

Practice location:
  • Phone: 215-336-8617
  • Fax: 215-334-5983
Mailing address:
  • Phone: 215-336-8617
  • Fax: 215-334-5983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP011027
License Number StatePA

VIII. Authorized Official

Name: MR. LUCA R CELLA
Title or Position: OWNER
Credential: CRNP ANP-BC WOCN
Phone: 215-336-8617