Provider Demographics
NPI:1376874990
Name:GANNETT, MARIA CELESTE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:CELESTE
Last Name:GANNETT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:CELESTE
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:825 OLD LANCASTER ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010
Mailing Address - Country:US
Mailing Address - Phone:610-525-1202
Mailing Address - Fax:610-527-0643
Practice Address - Street 1:825 OLD LANCASTER ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010
Practice Address - Country:US
Practice Address - Phone:610-525-1202
Practice Address - Fax:610-527-0643
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00274200363LA2100X
PASP010620363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care