MEDICARE: KELLY MARIE NOCELLA CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	26NR16792200	NJ
2	367500000X	Certified Registered Nurse Anesthetist	700451	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235594433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY MARIE NOCELLA CRNA

Provider Business Mailing Address
First Line	:	844 PERKIOMEN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2134
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 SOUTH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-7411
Country	:	US
Telephone Number	:	856-278-6469
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2015
Last Update Date	:	04/13/2022

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