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General NPI Number Information
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NPI Number | 1386379634
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Entity Type | Individual
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Provider Name | BREONNA KALI TRUSCELLO PA
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Gender | Female
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 167 ZEMAN DR
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City | EBENSBURG
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State | PA
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Zip | 15931-4103
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Country | US
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Telephone | 814-472-9119
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Fax |
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Provider Business Mailing Address
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Address Line | 640 KOLTER DR
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City | INDIANA
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State | PA
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Zip | 15701-3570
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Country | US
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Telephone | 724-357-7333
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA063745
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA063745
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License Number State | PA
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