Provider Demographics
NPI:1336497205
Name:MAGNARELLI, KELLI B (BSN,RN)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:B
Last Name:MAGNARELLI
Suffix:
Gender:F
Credentials:BSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 E WEST HWY
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-5918
Mailing Address - Country:US
Mailing Address - Phone:301-907-6718
Mailing Address - Fax:
Practice Address - Street 1:3807 E WEST HWY
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-5918
Practice Address - Country:US
Practice Address - Phone:301-907-6718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-26
Last Update Date:2012-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR154772163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse