Provider Demographics
NPI:1497958136
Name:ROCKELLI, LAURIE ANNE (PHD, CRNP-PMH)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:ANNE
Last Name:ROCKELLI
Suffix:
Gender:F
Credentials:PHD, CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 RIVERSIDE DR
Mailing Address - Street 2:STE 8
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5352
Mailing Address - Country:US
Mailing Address - Phone:410-548-3333
Mailing Address - Fax:410-548-3341
Practice Address - Street 1:505 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5020
Practice Address - Country:US
Practice Address - Phone:410-341-3420
Practice Address - Fax:410-341-3397
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR093795163WP0809X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD609550004Medicaid
MD609550002Medicaid
MD609550001Medicaid
MD410545100Medicaid