Provider Demographics
NPI:1225001142
Name:IANNUZZI, NELSON ANTHONY (CRNP)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:ANTHONY
Last Name:IANNUZZI
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 JEFFERSON AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1624
Mailing Address - Country:US
Mailing Address - Phone:570-342-1776
Mailing Address - Fax:570-207-1910
Practice Address - Street 1:746 JEFFERSON AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1624
Practice Address - Country:US
Practice Address - Phone:570-342-1776
Practice Address - Fax:570-207-1910
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007424363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP007424OtherCRNP LICENSE