Provider Demographics
NPI:1508485392
Name:PECORELLA, CHARISSE (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHARISSE
Middle Name:
Last Name:PECORELLA
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 SALT POINT TPKE
Mailing Address - Street 2:
Mailing Address - City:CLINTON CORNERS
Mailing Address - State:NY
Mailing Address - Zip Code:12514-2324
Mailing Address - Country:US
Mailing Address - Phone:845-807-2097
Mailing Address - Fax:
Practice Address - Street 1:21 READE PL
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3912
Practice Address - Country:US
Practice Address - Phone:845-214-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-11
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345564363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily