Provider Demographics
NPI:1437629904
Name:NELSON, ANNA MARIE PETRUNCIO (MPH, CHES, LMT, RYT)
Entity Type:Individual
Prefix:
First Name:ANNA MARIE
Middle Name:PETRUNCIO
Last Name:NELSON
Suffix:
Gender:F
Credentials:MPH, CHES, LMT, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 E ORMOND AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-1216
Mailing Address - Country:US
Mailing Address - Phone:609-922-0329
Mailing Address - Fax:
Practice Address - Street 1:22 E ORMOND AVE
Practice Address - Street 2:
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08107-1216
Practice Address - Country:US
Practice Address - Phone:609-922-0329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 174H00000X, 251K00000X
PAMSG004860225700000X
NJ18KT00767800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or Welfare