Provider Demographics
NPI:1437447059
Name:CARSELLO, JANICE M (MSN, CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:M
Last Name:CARSELLO
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:M
Other - Last Name:CHRISTINZIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 WOLF ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2912
Mailing Address - Country:US
Mailing Address - Phone:215-334-5315
Mailing Address - Fax:215-334-5305
Practice Address - Street 1:1300 WOLF ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2912
Practice Address - Country:US
Practice Address - Phone:215-334-5315
Practice Address - Fax:215-334-5305
Is Sole Proprietor?:No
Enumeration Date:2011-07-17
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011315363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102888480Medicaid
PA102888480Medicaid