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General NPI Number Information
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NPI Number | 1962776716
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Entity Type | Organization
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Legal Business Name | NP ADVANCED WOUND CARE LLC
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Dates
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Enumeration Date | 02/25/2012
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | 1635 CROATAN PL
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City | PHILA
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State | PA
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Zip | 19145-5403
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Country | US
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Telephone | 215-336-8617
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Fax | 215-334-5983
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Provider Business Mailing Address
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Address Line | 1635 CROATAN PL
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City | PHILA
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State | PA
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Zip | 19145-5403
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Country | US
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Telephone | 215-336-8617
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Fax | 215-334-5983
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Authorized Official
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Title or Position | OWNER
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Name | MR. LUCA R CELLA
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Credential | CRNP ANP-BC WOCN
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Telephone | 215-336-8617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | SP011027
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License Number State | PA
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