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NPI Code Detail

MEDICARE: MS. DELLA LERTPENMAETA CNP

MEDICARE: MS. DELLA LERTPENMAETA CNP
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
1363L00000XNurse PractitionerRN093485GA

General Provider Information

NPI Number : 1912997206
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DELLA LERTPENMAETA CNP
Provider Business Mailing Address
First Line : 4250 BROWNSVILLE RD
Second Line :
City : POWDER SPRINGS
State : GA
Zip : 30127-2559
Country : US
Telephone Number : 770-920-2280
Fax Number : 770-439-3555
Provider Business Practice Location Address
First Line : 4250 BROWNSVILLE RD
Second Line :
City : POWDER SPRINGS
State : GA
Zip : 30127-2559
Country : US
Telephone Number : 678-567-8000
Fax Number : 770-439-3555
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2005
Last Update Date : 12/27/2013

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