Provider Demographics
NPI:1558601815
Name:FANELLI, LORETTA GILLMAN (RN, MA, NPP)
Entity Type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:GILLMAN
Last Name:FANELLI
Suffix:
Gender:F
Credentials:RN, MA, NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 ALLERTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:718-519-5486
Mailing Address - Fax:718-652-7085
Practice Address - Street 1:668 ALLERTON AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-519-5486
Practice Address - Fax:718-652-7085
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400463-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner