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General NPI Number Information
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NPI Number | 1710984448
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Entity Type | Individual
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Provider Name | KELLI PUPO CRNA
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Gender | Female
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 03/21/2016
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Provider Practice Location Address
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Address Line | 130 SOUTH BRYN MAWR AVENUE FLOOR THREE
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City | BRYN MAWR
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State | PA
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Zip | 19010
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Country | US
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Telephone | 484-337-3000
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Fax | 610-527-5102
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Provider Business Mailing Address
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Address Line | 411 BERRY LN
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City | MEDIA
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State | PA
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Zip | 19063-1160
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Country | US
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Telephone | 610-566-5284
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN317545L
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License Number State | PA
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