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General NPI Number Information
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NPI Number | 1528454717
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Entity Type | Individual
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Provider Name | EMILY NARDIELLO PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 12/08/2016
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Provider Practice Location Address
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Address Line | 295 NE GILMAN BLVD STE 101
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City | ISSAQUAH
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State | WA
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Zip | 98027-2906
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Country | US
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Telephone | 425-391-2500
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Fax | 425-391-6464
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Provider Business Mailing Address
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Address Line | 1861 STURDY RD
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City | VALPARAISO
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State | IN
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Zip | 46383-8017
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Country | US
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Telephone | 219-548-0360
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Fax | 219-548-0358
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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 | 10001797A
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License Number State | IN
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