Healthcare Provider Details

I. General information

NPI: 1669885075
Provider Name (Legal Business Name): NICOLE ELISE PACELLA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE ELISE PACELLA

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 12/30/2022
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 VIRGINIA AVE
ROCHESTER PA
15074-1723
US

IV. Provider business mailing address

100 SHENANGO AVE
SHARON PA
16146-1503
US

V. Phone/Fax

Practice location:
  • Phone: 724-770-9095
  • Fax:
Mailing address:
  • Phone: 770-770-9095
  • Fax: 724-770-9096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN616173
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP025874
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: