Provider Demographics
NPI:1124575261
Name:LELLA, MARGO MARIE (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:MARIE
Last Name:LELLA
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:MARGO
Other - Middle Name:MARIE
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP
Mailing Address - Street 1:250 N SEE VEE LN
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-8130
Mailing Address - Country:US
Mailing Address - Phone:760-873-8464
Mailing Address - Fax:760-873-3935
Practice Address - Street 1:52 TU SU LANE
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-8058
Practice Address - Country:US
Practice Address - Phone:760-873-8464
Practice Address - Fax:760-873-3935
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2023-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95068616163WG0000X
CA95021401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice