Provider Demographics
NPI:1467641324
Name:GANELLI, ALICIA (NP)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:GANELLI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:FRANCISCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:95 ARCH ST. #300
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304
Mailing Address - Country:US
Mailing Address - Phone:330-376-7000
Mailing Address - Fax:330-253-0853
Practice Address - Street 1:95 ARCH ST. #300
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304
Practice Address - Country:US
Practice Address - Phone:330-376-7000
Practice Address - Fax:330-253-0853
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.09521363L00000X
OHCOA.09521-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFRNP257347Medicare PIN