Provider Demographics
NPI:1639795412
Name:MANZELLA, PRISCILLA (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:MANZELLA
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 MEADOW ST APT B
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-3542
Mailing Address - Country:US
Mailing Address - Phone:508-380-6799
Mailing Address - Fax:
Practice Address - Street 1:133 MEADOW ST APT B
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-3542
Practice Address - Country:US
Practice Address - Phone:508-380-6799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2274395163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse