Provider Demographics
NPI:1114955424
Name:FERRELLI, JOAN ALYS (APRN,BC)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:ALYS
Last Name:FERRELLI
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 HURLEY POND RD
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-4516
Mailing Address - Country:US
Mailing Address - Phone:732-681-0288
Mailing Address - Fax:
Practice Address - Street 1:3010 HURLEY POND RD
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-4516
Practice Address - Country:US
Practice Address - Phone:732-681-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00117700363LF0000X
NY332851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily