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General NPI Number Information
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NPI Number | 1003301920
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Entity Type | Individual
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Provider Name | JOHANNA MARIE FARINELLA NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 06/22/2018
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Last Update Date | 06/22/2018
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Provider Practice Location Address
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Address Line | 9501 ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19114-1025
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Country | US
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Telephone | 215-673-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 1870 AUGUST DR
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City | HUNTINGDON VALLEY
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State | PA
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Zip | 19006-1511
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Country | US
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Telephone | 215-322-2852
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AG04180018
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License Number State | PA
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