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NPI Code Detail

MEDICARE: LOUISA MICELI NP

MEDICARE: LOUISA MICELI NP
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
1363LP2300XPrimary Care Nurse PractitionerSP014923PA

General Provider Information

NPI Number : 1639566144
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOUISA MICELI NP
Provider Business Mailing Address
First Line : 4508 CHESTNUT ST
Second Line : SUITE 500
City : PHILADELPHIA
State : PA
Zip : 19139-3608
Country : US
Telephone Number : 215-573-3632
Fax Number : 215-573-6848
Provider Business Practice Location Address
First Line : 4508 CHESTNUT ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19139-3608
Country : US
Telephone Number : 610-787-9417
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2015
Last Update Date : 12/21/2021

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