Provider Demographics
NPI:1316211063
Name:KRELL, DENISE ELIZABETH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ELIZABETH
Last Name:KRELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12617 N 39TH WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-7308
Mailing Address - Country:US
Mailing Address - Phone:602-740-3514
Mailing Address - Fax:
Practice Address - Street 1:12617 N 39TH WAY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7308
Practice Address - Country:US
Practice Address - Phone:602-740-3514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP042978164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse